Achalasia is a condition caused by failure of relaxation of the lower esophageal sphincter. It affects the whole esophagus and is caused by degeneration of ganglion cells in the esophageal wall. Clinical manifestations include progressive dysphagia, regurgitation of undigested food, weight loss, and chest pain. Diagnosis involves barium swallow, high-resolution manometry, and endoscopy showing dilated esophagus and food residue. Treatment options include botulinum toxin injection, balloon dilatation, and Heller myotomy to disrupt the lower esophageal sphincter and improve symptoms.

1. ACHALASIA
ACHALASIA
Moderator:
Dr. Halah Mandora
Prepared & presented by:
Ebtesam Almajed, 439003552

2. TABLE OF CONTENTS
01
TERMINOLOGY
02
ANATOMY &
PHYSIOLOY
03
PATHOPHYSIOLOGY
04
CLINICAL
MANIFESTATIONS
05
DIAGNOSTIC APPROACH &
INVESTIGATIONS
06
MANAGEMENT

3. TERMINOLOGY
01

4. ACHALASIA
A chalasia
No Relaxation

5. ANATOMY &
PHYSIOLOGY
02

7. Layers of the Esophagus

8. Physiology of the Esophagus
 Upper sphincter relaxes when larynx lifted.
 Bolus enters esophagus.
 Peristalsis begins:
 Lower sphincter relaxes as Bolus approaches
o Circular fibers contract behind bolus

9. Innervation of the esophagus

10. ACHALASIA
ACHALASIA

11. Achalasia
 Achalasia affects the whole esophagus.
 Caused by failure of relaxation of the
lower esophageal sphincter.
 As the disease progresses, the obstructed
lower esophagus dilates, and peristalsis
becomes uncoordinated.

12. Etiology
 Achalasia is thought to be due to a partial
or complete degeneration of the ganglion
cells in the myenteric plexus.
 In the later stages of the disease loss of the
dorsal vagal nuclei within the brain stem

13. CLINCAL
MANIFESTATIONS
04

14.  The disease is most common in middle life (30–40 years old) but can
occur at any age.
 Females are affected more than males (3:2).
 Progressive dysphagia over several years, often greater for liquids than
solids in contrast to dysphagia from carcinoma.
 Gravity rather than peristalsis is responsible for food leaving the
esophagus and the patient finds it easier to eat when standing, but this is
nearly always incomplete, leaving residual food.
 Weight loss.
 Halitosis.
Clinical presentation

15.  Regurgitation of undigested food particularly at night, resulting in:
Clinical presentation
o Aspiration,
o Bouts of coughing,
o Pneumonia,
o And recurrent chest infections.
 Retrosternal pain, which gradually decreases in
severity as the esophagus loses peristaltic activity.

16. DIAGNOSTIC
APPROACH &
INVESTIGATIONS
05

17. Diagnostic approach & investigations
 Barium swallow: smooth narrowing
with proximal esophageal dilatation.
 High-resolution manometry:
uncoordinated abnormal contraction
patterns, which may be important in
predicting the outcome of treatment.

18. Diagnostic approach &
investigations
 Endoscopy: tight cardia and
food residue in the esophagus.
 The gastric gas bubble: is usually
absent.

20. Bird Beak Sign

22. TREATMENT
04

23. Botulinum toxin:
Endoscopic injection of botulinum toxin
in the lower esophageal sphincter gives
temporary symptom relief but the
effects wear off quite quickly.

24. Balloon Dilatation of the Lower Esophageal Sphincter

25.  Balloon dilatation of the gastroesophageal junction disrupts the lower
esophageal sphincter and improves symptoms in 80–90% of patients but
carries the risk of esophageal perforation.

27. ● Bailey & Love`s Short Practice of Surgery, 27th Edition
● Principles and Practice of Surgery, 7th Edition
● radiopaedia.org/articles/achalasia
REFERENCES