Achalasia is abnormal peristalsis and failure of relaxation of the lower oesophageal sphincter. It is believed to be due to degeneration of the myenteric plexus.

It classically causes dysphagia and regurgitation. It may also result in weight loss, chest pain and nocturnal cough.

Achalsia may be primary (=no obvious cause for the degeneration of the myenteric plexus) or secondary to a variety of conditions including Chagas disease.

Investigation is:
  • oesophageal manometry – the gold standard
  • barium swallow – characteristic ‘birds beak’ appearance
  • endoscopy
  • CXR – possibly mediastinal widening

Treatment options are:
  • Endoscopic balloon dilation
  • Surgical, eg. Hellers cardiomyotomy
  • Botulinum toxin injection
  • Nifedipine as a temporary measure

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


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