motility disorder

Question 1

What is achalasia?

Answer 1

a - meaning without
chalasia - meaning relaxation
a failure of relaxation of the lower oesophageal sphincter OR inability of the lower 2/3s of the oesophagus to perform peristalsis

Question 2

What are the clinical features of achalasia?

Answer 2

• usually progressive dysphagia to solids then fluids
• regurgitation
• retrosternal pain
• weight loss

Question 3

What are the investigations + results confirming achalasia?

Answer 3

-barium swallow - bird beak sign
-oesophageal manometry - GOLD STANDARD
-measures oesophageal pressure - incomplete or
absent sphincter relaxation +/- decreased
peristalsis + widened oesophagus
-OGD - is suspicious of Ca can biopsy
CXR - widened mediastinum

Question 4

What are the treatment options for achalasia?

Answer 4

• pneumatic balloon dilation
• lower oesophageal sphincter myotomy
• LOS botox injection
• calcium channel blockers or nitrates