Achalasia

Definition: aperistalsis of the oesophagus, failure of the cardiac sphincter to relax on swallowing.

Incidence: 1 per 100 000 per year.

Clinical features: Long history of intermittent dysphagia, aspiration pneumonia, retrosternal chest pain. Weight loss not usually marked.

Investigations:

• CXR: dilated oesophagus, no bubble in gastric fundus.
• Ba swallow: dilation of oesophagus, lack of peristalsis, beak deformity.
• Oesophagoscopy: Exclude carcinoma. Apparent stricture offers no resistance to passage of endoscope.
• Oesophageal manometry: demonstrates aperistalsis.

Treatment: Endoscopic dilatation of cardiac sphincter with pneumatic bag. SE: gastroesophageal reflux.

ΔΔx Chagas disease (American trypanosomiasis), oesophageal Ca, oesophageal spasm, oesophageal diverticulum, pharyngeal pouch, oesophageal web, benign oesophageal stricture, CREST.