Achalasia

Achalasia

Definition : Primary oesophageal motility disorder , characterized by failure of the lower oesophageal sphincter to relax and absence of oesophageal peristalsis

Symptoms:

• dysphagia ( both liquid and solid)
• heartburn
• regurgitation
• chest pain
• weight loss

Investigation:

a) Imaging :

• barium swallow: oesophagus appears dilated , contrast material passes slowly into the stomach as the LES opens intermittenly .Distal oesophagus is narrowed( resembling bird`s beak)

b) Prodecural

• OGDS  : to rule out ca of gastroeophageal junction or fundus

c) other test

• oesophageal manometry : to diagnose achalasia

1. incomplete relaxation of LES in response to swallowing
2. high resting LES pressure
3. absent of oesophageal peristalsis

• prolonged oesophageal pH monitoring : to rule out GERD

Treatment

• reduce LES pressure : calcium channel blockers and nitrates
• intrasphincteric injection of botulinum toxin : restore balance between excitatory and inhibitory neurotransmitters
• pneumatic dilatation surgery : balloon inflated at the gastroesophageal junction to rupture the muscle fibers