What is achalasia?
➡ It is a rare motor disease. It is a condition in which lower oesophageal sphincter fails to relax.
🔹Causes:
➡ Loss of inhibitory signals in the Meissner and Myenteric Plexus.
⬇️
Increase stimulatory impulse, results in contracted sphincter.
🔹Clinical Features:
➡ Usually a middle-aged adult.
➡ Dysphagia- which is intially to liquid then to solid.
➡ Dysphagia when unattended leads to weight loss and anaemia.
➡ Regurgitation (later stages to dilated oesophagus)
➡ Tracheal overspill (due to tracheal aspiration usually more at night)
➡ Aspiration pneumonia
🔹Diagnosis-
➡ Barium meal Xray:
Findings are:-
↪ Bird beak tapering stricture of dilated oesophagus.
↪ Absences of gastric bubble.
▶ Some times accidentally diagnosis is made during endoscopy
– dilated oesophagus with tight cardia and residual Food.
🔹Oesophageal manometry-
- ⬆ Resting pressure
- ⬆ Lower sphincter pressure.
🔹 Treatment-
➡ Pneumatic dilation
➡ Calcium channel antagonist
➡ Surgery- Modified Heller’s cardiomyotomy with anterior fundoplication.
▶Now lets see some differenciation between barium meal xray of achalasia and carcinoma oesophagus:
- Achalasia will result in the bird beak tapering end with regular margin
- Oesophageal cancer with barium swallow results in:
➡ Tapering stricture known as a “rat’s tail” (because of intraluminal tumor growth)
➡ Irregular stricture
➡ Pre-stricture dilatation
➡ Shouldering
▶ Achalasia patient usually doesn’t complain of heart burn, Why?
- Because the lower oesophageal sphincter is tight shut!
It is under so much pressure that acid regurgitation from stomach to oesophagus is almost impossible.
▶ Achalasia cardia V/S Hirschpung Disease :
➡ Achalasia occurs due to loss of inhibitory neurons in the Meissner’s and Myenteric plexus
➡ But in Hirschpung disease, entire rectosigmoidal junction is devoid of ganglion cells due to neural crest migration defect
⬇️
Absent Meissner’s plexus and intestinal dilation.
Sushmita Chowdhury
University of Science and Technology Chittagong
2015-16/
Platform academia / Tohfa Rahman Galib