Achalasia

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Achalasia

On swallowing:

  • absence of peristalsis in body of oesophagus
  • failure of lower oesophageal sphincter to relax

Pathogenesis

  • degenerative lesions found in vagus
  • decrease in ganglionic cells of myenteric plexus of oesophagus
  • NO-containing neurons more affected than cholinergic
  • 2/3 patients have autoantibodies to dopamine-carrying protein on surface of myenteric plexus

Epidemiology

  • 1/100,000 per year

Presentation

  • any age
    • rare in childhood
  • long history intermittent dysphagia
    • both liquids and solids
  • regurgitation
    • particularly at night
  • may be diagnosed as cardiac pain in younger patients

Investigations

  • CXR
    • dilated oesophagus
    • ? fluid level
    • absence of fundus gas bubble
  • Barium swallow
    • dilated oesophagus
    • lack of peristalsis
    • lower end gradually narrows
  • oesophagoscopy
  • manometry

Treatment

  • endoscopic dilatation of lower oesophageal sphincter

Complications

 

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