Achalasia

Background

• Inability of LES to relax and loss of normal peristalsis <ref>Krill JT, Naik RD, Vaezi MF. Clinical management of achalasia: current state

of the art. Clin Exp Gastroenterol. 2016 Apr 4;9:71-82.

Clinical Features

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

Evaluation

• 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
  • Consider gastrostomy for frail and older patients
• Patients need to eat upright at all times.
• Treatment may improve dysphagia, but there is no cure and swallowing never completely normalizes