- “results from damage to nerves in the oesophagus, preventing the oesophagus from squeezing food into the stomach”
- Aetiology/Pathogenesis: Unknown cause. Loss of nerve cell ganglia from Myenteric Plexus. Progresses: later may lose dorsal vagal nuclei within brainstem
- Features:
- Failure of peristalsis
- Failure of relaxation of LES
- Increased LES resting tone
- Epidemiology:
- 30-60 years
- 1/100 000/year
- Clinically:
- Dysphagia to SOLIDS AND LIQUIDS
- May be worse for liquids than solids
- Often drinking heaps of water gets food down
- Chest pain (due to spasms)
- Regurgitation (old food, undigested, especially AT NIGHT)
- Complications
- Aspiration pneumonia
- Oesophageal erosions, diverticula
- Oesophagitis: Candida
- Squamous Cell Carcinoma (5%)
- Investigations:
- Barium Swallow: “Rat’s tail” appearance (expanded or sigmoid shaped tube, tight/tapered distally)
- CXR: may reveal a dilated esophagus and absence of air in the stomach
- Esophageal manometry
- endoscopy – reveals a dilated esophagus that contains retained food; it may also reveal inflammation, small ulcers caused by residual food or pills, and candida infection
- Treatment:
- Short-term: nitrates, hydralazine (pain relief)
- Long-term:
- Endoscopic balloon dilatation (BUT: risk of perforation with procedure, chronic reflux)
- Heller’s procedure: Cardiomyotomy (BUT: chronic reflux)
Related