Nutrition and energy – Achalasia notes
Clinical definition Diagnosis Clinical presentation
Achalasia is a motility disorder defined
by the failure of lower oesophagus • Barium swallow X-ray and
• Presents with progressive
relaxation together with peristalsis continuous fluoroscopy
dysphagia equal with liquids
Shows appearance of dilated
to solids
oesophagus with absence of
• Weight loss
peristalsis
• Retrosternal chest pain with
Tight LOS with a ‘rat tail’ appearance
doesn’t improve with antacids
Pathophysiology • Typically presents in younger
people
• Progressive denervation of the
oesophagus
• Degeneration of the ganglion cells
Treatment options
within the myenteric plexus
• This causes incomplete LOS sphincter
relaxation and failure of peristalsis
(innervation to smooth muscle)
• Increased LOS muscle tone • In younger patients –
endoscopic dilatation
and disruption of LOS
• In older patients –
Endoscopic Botox
Potential complications Dilated injections to paralysis
oesophagus the LOS (required once
year or less)
Absence of • Surgical myotomy –
Rat tail Incision of the LOS,
• Oesophageal dilatation peristalsis
appearance allowing re-passage of
• Pooling of food and fluids can lead
to respiratory complications food and liquids
, Nutrition and energy – GORD notes #1
Risk factors - Summary Hernias
Clinical definition
GORD develops when the oesophageal mucosa is
exposed to gastroduodenal contents for prolonged
periods of time, resulting in symptoms, and often
a degree of oesophagitis
Pathophysiology
• Most common pathology is associated with
transient lower oesophageal sphincter
relaxations Rolling hiatus hernia
Often occurs in the daytime, with small or The cardia remains in a
no hiatus hernia normal position, however, a
Often no accompanying oesophagitis pouch of peritoneum
• More serve oesophagitis is less common Investigations containing the fundus of the
and occurs due to reduces tone of the LOS, stomach, extends through
with increased intra-abdominal pressures. the oesophageal hiatus
• Endoscopy and biopsy of any lesions Sliding hiatus hernia
• 24 Hr oesophageal PH monitoring – if the The cardia and parts of the
diagnosis is unclear or if surgical fundus slide superiorly
Risk factors intervention is under consideration through the oesophageal
• Pressure measurement within the hiatus into the thorax. This
Obesity and pregnancy Increased oesophagus - manometry occurs especially when
intra-abdominal pressures • Impedance testing – test for non-acidic someone lies down.
reflux into the oesophagus
Dietary fat, alcohol, chocolate, tea and
coffee Increased LOS relaxation
Clinical definition Diagnosis Clinical presentation
Achalasia is a motility disorder defined
by the failure of lower oesophagus • Barium swallow X-ray and
• Presents with progressive
relaxation together with peristalsis continuous fluoroscopy
dysphagia equal with liquids
Shows appearance of dilated
to solids
oesophagus with absence of
• Weight loss
peristalsis
• Retrosternal chest pain with
Tight LOS with a ‘rat tail’ appearance
doesn’t improve with antacids
Pathophysiology • Typically presents in younger
people
• Progressive denervation of the
oesophagus
• Degeneration of the ganglion cells
Treatment options
within the myenteric plexus
• This causes incomplete LOS sphincter
relaxation and failure of peristalsis
(innervation to smooth muscle)
• Increased LOS muscle tone • In younger patients –
endoscopic dilatation
and disruption of LOS
• In older patients –
Endoscopic Botox
Potential complications Dilated injections to paralysis
oesophagus the LOS (required once
year or less)
Absence of • Surgical myotomy –
Rat tail Incision of the LOS,
• Oesophageal dilatation peristalsis
appearance allowing re-passage of
• Pooling of food and fluids can lead
to respiratory complications food and liquids
, Nutrition and energy – GORD notes #1
Risk factors - Summary Hernias
Clinical definition
GORD develops when the oesophageal mucosa is
exposed to gastroduodenal contents for prolonged
periods of time, resulting in symptoms, and often
a degree of oesophagitis
Pathophysiology
• Most common pathology is associated with
transient lower oesophageal sphincter
relaxations Rolling hiatus hernia
Often occurs in the daytime, with small or The cardia remains in a
no hiatus hernia normal position, however, a
Often no accompanying oesophagitis pouch of peritoneum
• More serve oesophagitis is less common Investigations containing the fundus of the
and occurs due to reduces tone of the LOS, stomach, extends through
with increased intra-abdominal pressures. the oesophageal hiatus
• Endoscopy and biopsy of any lesions Sliding hiatus hernia
• 24 Hr oesophageal PH monitoring – if the The cardia and parts of the
diagnosis is unclear or if surgical fundus slide superiorly
Risk factors intervention is under consideration through the oesophageal
• Pressure measurement within the hiatus into the thorax. This
Obesity and pregnancy Increased oesophagus - manometry occurs especially when
intra-abdominal pressures • Impedance testing – test for non-acidic someone lies down.
reflux into the oesophagus
Dietary fat, alcohol, chocolate, tea and
coffee Increased LOS relaxation
