Post on 15-Jul-2015
Pain with or with out swallowing.usually
intermittent
Associated with GORD or a part of diffuse GI
motility disorders
Barium impregnated food bolus seen to stick to oesophagus
DISORDERS OF PHARYNGO-OESOPHAGEAL JN
Neurological-stroke ,motor neurone ds
,multiple sclerosis,parkinsons ds.
Myogenic-myasthenia gravis,mus dystrophy
Pharyngo-oesophageal(zenkers) diverticulum
AUTOIMMUNE DISORDERS-ESPECIALLY
SYSTEMIC SCLEROSIS(CREST-
calcinosis,raynaud’s synd,esoph motility
disorders,sclerodactyly,telangiectasia) REFLEX ASSOCIATED
IDIOPATHIC
LOSS OF GANGLION CELLS IN MYENTERIC
PLEXUS IN LOWER OESOPHAGUS
DILATATION , TORTUOSITY $ HYPERTROPHY
OF PROXIMAL OESOPHAGEAL SEGMENT
HISTOLOGY -REDUCTION IN NO: OF GANGLION
CELLS WITH VARIABLE DEGREE OF C/C INFLMTN
VIGOROUS ACHALASIA-NORMAL NO: OF
GANGLION CELLS WITH INFLMTN AND NEURAL
FIBROSIS
AETIOLOGY:IDIOPATHIC, ASSOC WITH CHAGAS
DS,STRESS $ EMOTIONAL FACTORS, VIT DEF
WOMEN AROUND 30-40 YRS COMMONLY
AFFECTED M:F=2:3
DYSPHAGIA MAINLY FOR LIQUIDS
RECCURENT RESP TRACT INFN
COMPLICATIONS-INCREASED INCIDENCE OF
CARCINOMA
Achalasia like usually produced by
adenocarcinoma of cardia and also by benign
tumors at this level
Inability of sphincter to relax is due to
absent body peristalsis
Also seen in carcinoma of bronchus $
pancreas
1. BARIUM SWALLOW-uniform dilated oesph above
with tapering segmet below(BIRDS BEAK)
2. Oesophagoscopy-tight cardia and food residue
in oesophagus
3. PLAIN X-RAY ABD ERECT-ABSENTGASTRIC GAS
BUBBLE
4. Lower oesophageal sphincter pressure may be
increased
5. Oesophageal manometry:show simultaneous contrn
of oesoph body $ incomplete relxn of los
Forceful dilatation of
cardia:stretching of cardia with
balloon to disrupt muscle and render it
less competent.balloons of 30-40 mm
diameter inserted over guideline.
Hellers myotomy:it involves cutting
muscle of lower oesophagus and
cardia.used after failed dilatation.90%
success
Botulinum toxin:interfere with cholinergic
excitatory neural activity at LOS.effect is
permanent so repeated for months.used in
elderly.
DRUGS:relieve symptoms.CALCIUM CHANNEL
BLOCKERS:Nifedipine S/L