Synonym: Achalasia of oesophagus.
Definition: Failure of the lower oesophageal sphincter to relax resulting in dilatation and hypertrophy of oesophagus without any demonstrable obstructive lesion.
- Due to spasm of cardiac sphincter.
- Functional obstruction due to achalasia, i.e. failure of relaxation. The Auerbach’s plexus located between longitudinal and circular muscle is present but defective.
- Congenital abnormality like megaoesophagus.
- Associated with vitamin B deficiency and trypanosomiasis (Chaga’s disease).
- Oesophagus is dilated, often grossly, dilatations being most obvious in distal two-third.
- Considerable muscular hypertrophy.
- Mucous membrane is stretched, thinned and shows features of inflammation and sometimes ulceration.
- Dilatation when traced downwards, narrows in a funnel shaped manner but a short distance above cardiac end, the oesophagus attains normal dimensions. Muscular movements are normal in last inch of oesophagus.
- Age: Often female above 40.
- Long standing dysphagia with
a) Insidious onset.
b) Intermittent symptoms.
c) More with liquids and less with solids.
d) Patient complains of vomiting which is ‘oesophageal pseudo- vomiting’, several hours after a meal.
- Retrosternal or inter scapular discomfort.
- Aspiration pneumonitis may be present.
Special investigations: 1. Barium meal examination:
a) Pencil shaped narrowing of lower segment of oesophagus. Enormous dilatation of oesophagus with smooth termination of barium meal.
b) Absence of gas bubble in stomach.
c) Inco-ordinated peristalsis of oesophagus.
2) Oesophagoscopy:(Rigid or Flexiable)
- Grossly dilated lower oesophagus.
- Cardiac orifice difficult to see due to spasm.
Medical: Drugs such as probanthine.