Sunday, 26 September 2010

MRCP revision battle 21.5: Achalasia

Achalasia is abnormal peristalsis and failure of relaxation of the lower oesophageal sphincter.

It causes dysphagia, regurgitation, chest pain and weight loss.

Females aged 30-50 are most commonly affected.

Investigation is with oesophageal manometry and barium swallow.
The barium swallow should show a characteristic 'birds beak' appearance (image below is from wiki commons):

Treatment is with balloon dilation or hellers cardiomyotomy.    Nifedipine may be temporarily helpful.

A rare and late complication of achalsia can be squamous carcinoma.

Now on to battle 21.6, which is short but sure to make you itch...