Achalasia

Exam Cram

• Achalasia is a oesophageal disorder of failure to relax the lower oesophageal sphincter causing a functional obstruction at the gastro-oesphageal junction

• Presentation: solids and liquids dysphagia, barium swallow- bird beak appearance 

• Diagnosis: manometry- high resting oesphageal tone

• Management: pneumatic dilatation

Outline

Assessment

History:

• Dysphagia initially solids then both solids & liquids

• No weight changes

Examination

• Normal

Investigations

• Normal FBC, EUC, CRP, LFTs

• Barium swallow: Bird Beak Appearance

• Endoscopy: normal

• Oesphageal manometry- high oesphageal resting tone

Diagnosis

Diagnostic criteria: oesphageal manometry- high oesphageal resting tone

Differentials: oesphageal cancer

Management

• Pneumatic dilatation (poor functional status)

• Surgery: Heller's myotomy (good functional status)

• Botulim toxin (provides short term relief)

Med Reg Notes

Procedural Options

Heller's myotomy 

• Success rates 90% 

• Complications: bleeding, perforation, Vagus nerve injury, GORD

Pneumatic dilatation

• • Success rates 90%

  • Complications: perforation (10%)

Complications

Achalasia associated with increased Oesphageal Cancer rates. 

References

1. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014 Jan 4;383(9911):83-93. doi: 10.1016/S0140-6736(13)60651-0. Epub 2013 Jul 17. PMID: 23871090. 

2. Momodu II, Wallen JM. Achalasia. [Updated 2023 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/

Written in 2025