Transcript Achalasia

Achalasia
Prof. Dr. Faisal Ghani Siddiqui
Preamble
• Introduction
• Pathogenesis
• Clinical findings
• Investigations
• Differential diagnosis
• Complications
• Treatment
Oesophageal Peristaltic
Waves
• Primary
• Secondary
• Tertiary
Oesophageal Motility
Disorders
Primary
• Unknown causes
Secondary
• Manifestations of systemic diseases
Oesophageal Motility Disorders
Primary
Secondary
• Achalasia
• Oesophageal spasm
• Nutcracker oesophagus
• Hypertensive LES
• Diabetes mellitus
• Scleroderma
• Alcohol
• Psychiatric illnesses
Pathogenesis
Loss of Myenteric
plexus of
Auerbach
(postganglionic
nitrinergic
inhibitory
ganglions)
Achalasia -aetiology
Primary Motility Disorder
Absence of Primary oesophageal
waves + LES hypertensive
Impaired propulsion of food
Dysphagia | Regurgitation |
Heartburn | Chest pain
Clinical Findings
• Dysphagia
• Regurgitation
• Heartburn
• Chest pain
Dilated proximal
Oesophagus
Distal
Oesophageal
narrowing
(bird’s beak)
Oesophageal Manometry
• Absence of oesophageal
peristalsis
• Partial or no relaxation of
LES
Differential Diagnosis
• Benign strictures
• Oesophageal carcinoma
Complications
• Aspiration | pneumonia
• Chronic irritation | carcinoma oesophagus
Treatment
• Medical treatment
• Endoscopic treatment
• Surgical treatment
Intersphincteric Injection of
Botulinum Toxin
Pneumatic Dilatation
Heller Myotomy
… in summary
• Primary motility disorder
• Absence of primary peristaltic waves &
hyperactive LES
• Dysphagia
• Manometry diagnostic
• Pneumatic dilatation | Heller myotomy