WHAT IS ACHALASIA HOW IT IS CAUSED HOW IT CAN BE TRAETED DRUGS TO TREAT

1. ACHALASIA
NALI SOMASHEKAR SANTHOSH

2. OBJECTIVES
• INTRODUCTION
• CAUSES
• DISEASE ASSOCIATED
• PATHOPHYSIOLOGY
• CLINICAL FEATURES
• DIAGNOSIS
• TREATMENT
• COMPLICATIONS

3. INTRODUCTION
• achalasia is also called as oesophageal achalasia or achalasia cardia
• It is a primary oesophageal mobility disorder
• It is characterised by the absence of oesophageal peristalsis, impaired LES
• food swallowed into the oesophagus then fails to pass to stomach
• Usually occurs in middle age(can occur in any age)

5. • IT OCCURS DUE TO:
• 1) failure of relaxation of lower oesophageal sphincter (LES)
• 2)loss of ganglion cells in myenteric/Auerbach in lower esophageal sphincter.
• So they doesn’t relax
• CAUSES:
• Unknown but many theories suggest( infectious, hereditary, autoimmune)

6. • It can be associated with
• Carcinoma of lower end of oesophagus
• Stricture of lower end of oesophagus
• Scleroderma
• Pancreatic or bronchial cancer
• Hiatal hernia
• Chagas’ disease

7. PATHOPHYSIOLOGY

8. CLINICAL FEATURES
• regurgitation ( earliest features )
• Dysphagia- initially more to liquids >> solids
• Halitosis
• Pain
• Weight loss
• Aspiration pneumonia
• Lung abscess

9. DIAGNOSIS
• Barium swallow
• “Birds beak” appearance
• Endoscopy
• will show closed LES with dilated
oesophagus and accumulation of
food

10. • Oesophageal manometry
• This involves placing a tube in the oesophagus while the patient swallows and the
tube records the muscle activity
• NORMAL INTRAESOPHAGEAL PRESSURE(IEP)= 10-25 mm of hg
• In achalasia IEP is 25-100 mm of hg
• It is a GOLD STANDARD INVESTIGATION

11. ACCORDING TO MANOMETRY: TYPES

12. TREATMENT
• CONSERVATIVE THERAPY:
• Aim to help to relax LES by
• calcium channel blockers and nitrates
• Anticholinergic drugs
• Sedatives

13. • Surgical procedures:-
• Myotomy to relax LES :
• 1) per oral endoscopic myotomy
• 2) heller’s operation
• Complication of the surgical procedures:- reflux
• To avoid reflux- fundoplication should be done

15. • Pneumatic balloon dilation also done
• Good short term results
• Need repeated dilation
• Risk of this procedure- oesophageal rupture

16. COMPLICATIONS OF ACHALASIA
• OESOPHAGUS:-
• Malnutrition, progressive dilation, retention oesophagitis, oesophageal cancer
• RESPIRATORY:-
• Aspiration pneumonia, dyspnea due to extrinsic tracheal compression

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