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

•Achalasia•Oesophageal spasm

•Nutcracker oesophagus

•Hypertensive LES

Secondary

•Diabetes mellitus•Scleroderma•Alcohol

•Psychiatric illnesses

Pathogenesis

Achalasia -aetiology

Clinical Findings

• Dysphagia• Regurgitation• Heartburn• Chest pain

Distal Oesophageal narrowing(bird’s beak)

Dilated proximal Oesophagus

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

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