·
Etiology:
??
·
Aperistalsis
of esophagus & failure of relaxation of LES (i.e. contracted) on initiation of
swallowing.
·
Chagas’
disease (American trypanosomiasis = T. cruzi)
à
Damaged
neural plexus à
Achalasia.
Pathology
Absence
of gangilionic cells (Auerbach’s plexus)
à
Narrowed
lower esophagus end
à
Dilation
of rest of esophagus
à
Congested,
ulcerated mucosa.
Clinical
Features:
1.
Chronic intermittent dysphagia.
2.
Regurgitation
of food, esp. at night.
3.
Chest
pain.
N.B.
Weight loss is not usually marked.
Investigations
1.
CXR:
o
Dilated esophagus.
o
No fundal gas shadow.
o
Aspiration pneumonia.
2.
Barium swallow:
o
Dilated esophagus.
o
Beak deformity.
3.
Esophagoscopy:
o
Exclude cancer.
o
Esophagoscope easily
flops through narrowing without resistance.
4.
Manometry
Treatment
Interrupt the tight fibers in lower esophagus end.
1.
Plummer’s
pneumatic bag à
Forcible dilation of LES.
§
Can lead to rupture of
esophagus !
2.
Esophago-cardio-myotomy
(Heller’s operation):
§
Performed
laparoscopically.
Complications
1.
↑
Incidence (5-10%) of cancer.
2.
Aspiration pneumonia.
3.
Reflux esophagitis.
4.
Diverticula (due to
raised intra-luminal pressure).
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