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...