📋 HISTORY
A 38-year-old woman presents with a 6-month history of progressive difficulty swallowing both solids and liquids.
🔹 Regurgitation of undigested food
🔹 Occasional chest pain
🔹 Lost 5 kg over 3 months
🔹 Barium swallow shows smooth narrowing at the GE junction with proximal dilatation
――――――――――――――
🔬 INVESTIGATIONS
🔹 Barium swallow: Bird beak appearance at distal esophagus
🔹 Chest X-ray: Widened mediastinum, absent gastric air bubble
🔹 Upper GI endoscopy: No mucosal lesion found
――――――――――――――
❓ QUESTION
Which investigation is the GOLD STANDARD for confirming the diagnosis in this patient?
https://www.effectivecpmnetwork.com/p6x5cixrpy?key=0e3ba72754512fdd23ee8b77a5e394ed
A 38-year-old woman presents with a 6-month history of progressive difficulty swallowing both solids and liquids.
🔹 Regurgitation of undigested food
🔹 Occasional chest pain
🔹 Lost 5 kg over 3 months
🔹 Barium swallow shows smooth narrowing at the GE junction with proximal dilatation
――――――――――――――
🔬 INVESTIGATIONS
🔹 Barium swallow: Bird beak appearance at distal esophagus
🔹 Chest X-ray: Widened mediastinum, absent gastric air bubble
🔹 Upper GI endoscopy: No mucosal lesion found
――――――――――――――
❓ QUESTION
Which investigation is the GOLD STANDARD for confirming the diagnosis in this patient?
🅐 Barium swallow
🅑 Upper GI endoscopy
🅒 Esophageal manometry
🅓 CT scan of the chest
❓ FAQ: Achalasia Cardia
1. What is achalasia?
A motility disorder of the esophagus characterized by failure of the lower esophageal sphincter (LES) to relax and absent peristalsis.
2. What causes achalasia?
Degeneration of inhibitory neurons in the myenteric plexus, leading to unopposed LES contraction.
3. What are the typical symptoms?
Progressive dysphagia to both solids and liquids, regurgitation, weight loss, and occasional chest pain.
4. What does barium swallow show?
A characteristic "bird beak" appearance with dilated proximal esophagus and tapering at the GE junction.
5. What is the gold standard investigation?
Esophageal manometry, showing absent peristalsis and incomplete LES relaxation.
6. Why is endoscopy performed?
To exclude pseudoachalasia caused by malignancy at the GE junction.
7. What are the treatment options?
Pneumatic dilatation, Heller myotomy, peroral endoscopic myotomy (POEM), or botulinum toxin injection.
8. What is the first-line treatment in young fit patients?
Surgical Heller myotomy or POEM, due to better long-term outcomes.
9. What is a serious long-term complication?
Increased risk of esophageal squamous cell carcinoma due to chronic stasis.
10. Is achalasia curable?
No, but symptoms can be effectively managed with the above treatments long-term.
1. What is achalasia?
A motility disorder of the esophagus characterized by failure of the lower esophageal sphincter (LES) to relax and absent peristalsis.
2. What causes achalasia?
Degeneration of inhibitory neurons in the myenteric plexus, leading to unopposed LES contraction.
3. What are the typical symptoms?
Progressive dysphagia to both solids and liquids, regurgitation, weight loss, and occasional chest pain.
4. What does barium swallow show?
A characteristic "bird beak" appearance with dilated proximal esophagus and tapering at the GE junction.
5. What is the gold standard investigation?
Esophageal manometry, showing absent peristalsis and incomplete LES relaxation.
6. Why is endoscopy performed?
To exclude pseudoachalasia caused by malignancy at the GE junction.
7. What are the treatment options?
Pneumatic dilatation, Heller myotomy, peroral endoscopic myotomy (POEM), or botulinum toxin injection.
8. What is the first-line treatment in young fit patients?
Surgical Heller myotomy or POEM, due to better long-term outcomes.
9. What is a serious long-term complication?
Increased risk of esophageal squamous cell carcinoma due to chronic stasis.
10. Is achalasia curable?
No, but symptoms can be effectively managed with the above treatments long-term.
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