Achalasia

Background

• Inability of LES to relax and loss of normal peristalsis

Clinical Features

• Dysphagia
• Regurgitation
• Chest pain
  • Esophageal spasm can be eight, crushing retrosternal much like ACS

Diagnosis

• Upper GI
  • Esophageal dilatation
  • Birds beak sign

Barrium swallow showing birds beak appearance

• Esophageal Manometry

Aperistaltic contractions, increased intraesophageal pressure, and failure of relaxation of the lower esophageal sphincter.

Management

• Trial of antispasmodic for Esophageal Spasm
  • Nifedipine
  • Surgical intervention
• Baloon dilatation
• Botulinum toxin injection
• Myomectomy