Definition
achalasia A slackening, Failure to relax; referring especially to
visceral openings such as the pylorus, cardia, or any other
sphincter muscles. |
Radiographic Appearance
On a plain chest film the oesophagus appears dilated and
extends into the right side of the chest cavity, often seen as
opaque when filled with food.
CXR - widening of mediastinum, air / fluid level and absence of
gastric fundus gas bubble
Barium Swallow - dilatation & residue, small tertiary contractions
and 'rat tail' of distal oesophagus |
Pathology
An obstruction which develops in the terminal oesophagus just
proximal to the card oesophageal junction, the upper oesophagus
becoming dilated and filled with retained food; sometimes originates
from a loss of motor innervation by fibres originating in the dorsal
nucleus of the vagus nerve.
Aetiology is unknown but a neurotropic virus may be important.
- Commonest in patients between 40 - 70 years
- Male : female ratio is approximately equal
- Symptoms include dysphagia, weight loss, regurgitation, chest
pain
- 5% of patients develop squamous carcinoma
Treatment
Conservative treatment may include endoscopic dilitation,
if unsuccessful general surgery may be indicated.
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Image 1 CXR
Image 2 Barium Swallow
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