Achalasia In Short

What is achalasia?

➡ It is a rare motor disease. It is a condition in which lower oesophageal sphincter fails to relax.


➡ 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


➡ Barium meal Xray:
Findings are:-
↪ Bird beak tapering stricture of dilated oesophagus.
↪ Absences of gastric bubble.

Figure : Bird’s beak deformity

▶ 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
Platform academia / Tohfa Rahman Galib

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