Achalasia

Achalasia, a rare oesophageal motility disorder, is diagnosed through a combination of barium swallow, upper endoscopy, and esophageal manometry, with treatment focused on relieving symptoms like difficulty swallowing (dysphagia). Treatment options include medications like nitrates or nifedipine, endoscopic procedures like balloon dilation or botulinum toxin injections, and surgical interventions such as laparoscopic Heller myotomy or peroral endoscopic myotomy (POEM).

Diagnosis:

· Barium Swallow:

This test involves drinking a barium solution that highlights the oesophagus on X-ray, allowing doctors to visualize any abnormalities in its structure and function.

· Upper Endoscopy:

A thin, flexible tube with a camera (endoscope) is inserted into the oesophagus to visually inspect the lining and rule out other conditions. It also allows for biopsies to be taken if needed.

· Oesophageal Manometry:

This test measures the pressure waves in the oesophagus, which are crucial for diagnosing achalasia. It assesses the lower oesophageal sphincter's (LOS) ability to relax and the oesophageal body's ability to contract properly.

Treatment:

· Medications:

Nitrates and calcium channel blockers can help relax the LES muscles, making it easier to swallow. However, they are often used as a temporary measure or as an adjunct to other treatments.

· Endoscopic Treatments:

· Pneumatic Dilation: A balloon is inserted into the LES and inflated to stretch and weaken the muscle, improving swallowing.

· Botulinum Toxin Injection: Injections of botulinum toxin into the LES can temporarily paralyze the muscle, reducing its tightness and improving swallowing. This is often used in patients who are not good candidates for other treatments or who have relapsed after other therapies.

· Surgical Treatments:

· Laparoscopic Heller Myotomy: A surgical procedure that involves cutting the muscles of the LES to relieve pressure and improve swallowing. A partial fundoplication (wrapping the stomach around the oesophagus) is often performed to prevent gastroesophageal reflux after the myotomy.

· Peroral Endoscopic Myotomy (POEM): A minimally invasive endoscopic procedure where a tunnel is created inside the esophageal wall, and the LES muscle is cut. POEM is a newer approach that offers similar results to laparoscopic Heller myotomy.