Achalasia
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Introduction
Achalasia is an esophageal motility disorder caused by an absence of esophageal perastalsis and an inability of the lower esophageal sphincter to relax during swallow.
The state of tonic LES increased tone and decreased motility, resulting in backup of food. It is not a mechanical disorder, but rather a motility problem.
The Case of...
Causes and Risk Factors
Incidence is 1:100,000
Pathophysiology
Achalasia is caused by an imbalance of excitatory and inhibitory neural signaling, often caused by an absence of inhibitory ganglion cells.
The leads to a loss of paristalsis and a loss of relaxation of the lower esophageal sphincter. Chronic dilation of the esophagus follows.
Signs and Symptoms
- history
- physical exam
History
Symptoms include
- dysphagia
- regurgitation
- halatosis
- chest pain
- acid reflux
- weight loss
Physical Exam
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Diagnostic Imaging
Barium swallow often reveals a dilated esophagus with a tapered narrowing (bird's beak) at the GE junction.
Differential Diagnosis
The differential includes:
- gastric carcinoma
- esophageal carcinoma
- Chagas disease
Treatments
Achalasia was traditionally treated with baloon dilatation via endoscopy. It has a success rate of 66%. Another option is a myotomy of the LES, either via thoracotmomy or laparascopy, followed by Nissen fundiplication to prevent reflux.
Consequences and Course
Additional Resources
Topic Development
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