This is a Barium Swallow of a 24 year young girl who was complaining of difficulty in swallowing Solid food as well as Liquids recently.Difficulty in swallowing is more prominent when she was taking solid foods. she also has experienced a retrosternal chest pain while she was  eating.Recently her weight has been reduced by 4.3kg.Comment on her Ba Swallow?


ANSWER -  Achalasia, including the bird's beak deformity and a dilated esophagus


Achalasia is a  an esophageal motility disorder in which neuromuscular failure involving the ganglion cells of Auerbach's myenteric plexus in the lower oesophageal sphincter and oesophageal body results in failure of relaxation at the lower end of the oesophagus with progressive dilatation.Achalasia  more commonly occurs in the third to fourth decades.There is no sex predominance.

CLINICAL FEATURES

  • Gradually progressive, intermittent dysphagia
  • Dysphagia is more marked for solids than liquids
  • Regurgitation of fluids from the oesophageal sac may be followed by an aspiration pneumonia or vomiting
  • Chest pain
  • Coughing when lying in a horizontal position
  • Signs of chronic malnourishment.

INVESTIGATIONS

Barium swallow - acute tapering at the LOS and narrowing at the gastro-esophageal junction, producing a "bird's beak" or "rat's tail" deformity

Esophageal manometry - high resting tone of the LOS


Esophagogastroduodenoscopy  with or without endoscopic ultrasound,  rule out the possibility of cancer


Biopsy - shows hypertrophied musculature and nerve cells of ENTERIC PLEXUS


TREATMENT

  • Mainly to relieve the distal obstruction  Intrasphincteric injection of botulinum toxin to paralyse the Lower esophageal spinchter
  • Calcium channel blockers or nitrates
  • Endoscopic hydrostatic or pneumatic dilatation
  • Heller's operation - cardiomyotomy - cut distal 3 to 4 cm of oesophageal muscle longitudinally -helps 90% of achalasia patients

Life style modifications

  • Need to eat slowly
  • Drink plenty of water with meals
  • Avoid eating near bedtime
  • Raising the head end of the bed
  • Proton pump inhibitors after surgery or pneumatic dilatation


Complications

  •     Aspiration pneumonia
  •      Haemorrhage
  •      Oesophageal carcinoma
  •      Gastroesophageal reflux occurs after  pneumatic dilatation is usually prevented by partial fundoplication surgery

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8 comments

  1. dr.ainulwara Says:
  2. achalasia cardia

     
  3. Anonymous Says:
  4. Cardiac achalasia. X-ray shows dilated esophagus with narrowed "rat tail" lower end (bird beak)

     
  5. yoho Says:
  6. proximal esophageal dilatation
    strictur in the lower part, smoth without sholdering

    waight loss is not significant

    acalasia cardi

     
  7. Anonymous Says:
  8. achlasia of chardia

     
  9. Anonymous Says:
  10. Ba Swallow shows dilation in lower end of esophagus.....
    Cardia Achlasia

     
  11. Anonymous Says:
  12. Ba swallow is characteristic of Achlasia of cardia with birds beak appearance

     
  13. Anonymous Says:
  14. achalasio

     
  15. Anonymous Says:
  16. Achalasia cardia.
    i would suggest MAGNESIUM supplementation to relax the sphincter muscles, a very practical and effective way to correct the disorder.

     

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