Achalasia Flashcards
what is achalasia
disturbance of normal muscular esophageal activity due to failed/incomplete relaxation of LES. passage of food into stomach is delayed. affects swallowing
function of LES
allows oesophageal peristalsis and contents pf oesophagus to empty into the stomach. also prevents gastroesophageal reflux
aetiology of achalasia
not fully understood. loss of ganglion cells in the myenteric plexus in oesophagus
function of myenteric plexus
controls and regulates oesophageal peristalsis
epidemiology
any age; 25-60
female to male ratio is 1:1
annual incidence is 1 / 100,000
risk factors
achalasia is risk factor for esophageal squamous cell carcinoma; ESCC (16 x)
measles, herpes simplex, hla II, autoimmune diseases, allgrove syndrome
how does achalasia present
insidious onset AND gradual progession of symptoms
presenting symptoms
intermittent dysphagia, difficulty belching, regurgitation, heartburn, chest pain and weight loss
why do patients lose weight with achalasia
not swallowing so less food eaten
examination findings in achalasia
aspiration pneumonia, malnutrition and weight loss
what is aspiration pneumonia
breathes in the food rather than swallowing it
what investigations will be done for achalasia
Chest X-ray,
barium swallow,
endoscopy,
manometry
Chest X-ray findings
widened mediastinum, dilated oesophagus causing double right heart border, air fluid level in the upper chest, absence of normal gastric bubble
barium swallow
dilated oesophagus that tapers down to sphincter; beak-shaped
endoscopy
excludes malignancy that could mimic achalasia
