Achalasia

Prof. Dr. Faisal Ghani Siddiqui

Preamble
Introduction
Pathogenesis
Clinical findings
Investigations
Differential diagnosis
Complications
Treatment

Oesophageal Peristaltic
Waves
Primary
Secondary
Tertiary

Oesophageal Motility
Disorders
Primary
Unknown causes

Secondary
Manifestations of systemic diseases

Oesophageal Motility Disorders

Primary

Secondary

Achalasia
Oesophageal spasm
Nutcracker oesophagus
Hypertensive LES

Diabetes mellitus
Scleroderma
Alcohol
Psychiatric illnesses

Pathogenesis
Loss of Myenteric
plexus of
Auerbach
(postganglionic
nitrinergic
inhibitory
ganglions)

Achalasia -aetiology
Primary Motility Disorder
Absence of Primary oesophageal
waves + LES hypertensive

Impaired propulsion of food

Dysphagia | Regurgitation |
Heartburn | Chest pain

Clinical Findings
Dysphagia
Regurgitation
Heartburn
Chest pain

Dilated proximal
Oesophagus

Distal
Oesophageal
narrowing
(birds beak)

Oesophageal Manometry
Absence of oesophageal
peristalsis

Partial or no relaxation of
LES

Differential Diagnosis
Benign strictures
Oesophageal carcinoma

Complications
Aspiration | pneumonia
Chronic irritation | carcinoma oesophagus

Treatment
Medical treatment
Endoscopic treatment
Surgical treatment

Intersphincteric Injection of
Botulinum Toxin

Pneumatic Dilatation

Heller Myotomy

 in summary
Primary motility disorder
Absence of primary peristaltic waves &
hyperactive LES
Dysphagia
Manometry diagnostic
Pneumatic dilatation | Heller myotomy