MRCS Knowledge: Achalasia
20/08/14 13:06 Filed in: MRCS Knowledge
Today’s MRCS Core Knowledge focuses on Achalasia
Background
Achalasia is the absence of oesophageal peristalsis and failure of relaxation of the lower oesophageal sphincter (LOS) due to degeneration of the myenteric plexus
Aetiology
Peaks in young adulthood and elderly
Signs and Symptoms
Slowly progressive dysphagia, liquids >solids, regurgitation as disease progresses, weight loss, aspiration, chest pain
Investigations
Barium swallow: has classic ‘birds beak’ appearance with a tapered distal oesophagus and dilated mega oesophagus proximal to the constriction
OGD: exclude benign/malignant strictures
Oesophageal manometry: abnormally high lower oesophageal sphincter pressures
Management
Endoscopic: balloon dilatation, botox injections
Surgical: Heller’s myotomy open or laparoscopic
Prognosis
Balloon dilatation is successful in 80%
Complications include: aspiration pneumonia and malignant change in distal oesophagus
Further Info:
For further info and commonly asked questions on achalasia be sure to sign up to the Question Bank.
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