Achalasia

• Achalasia is a primary motility disorder of the oesophagus that is characterised by failure to relax of the lower oesophageal sphincter.
• The cause of achalasia can be broadly divided into primary and secondary:

  • Primary: there is loss of inhibitory neurons in the wall of the oesophagus, but the exact cause is unknown. Also known as idiopathic
  • Secondary: any condition that prevents lower oesophageal opening other than primary denervation. Also known as ‘pseudoachalasia’
• Secondary achalasia is commonly due to gastrointestinal malignancy with invasion into and around the gastro-oesophageal junction
• Symptoms:

  • Dysphagia - solids and liquids
  • Regurgitation of undigested food
  • Vomiting
  • Difficulty belching
  • Weight loss
  • Chest pain
  • Aspiration
  • Heartburn - irritation of the oesophagus due to uncleared food
• Investigations:

  • OGD
  • Barium swallow - bird beak appearance
  • Manometry - measures pressure - confirms diagnosis
• Management:

  • Pneumatic dilatation
  • Peroral endoscopic myotomy
  • Surgical myotomy
• The major complication of achalasia is aspiration pneumonia