Dr.

Mohamed Mustafa Marzouk

Professor of Surgery
 Achalasia of the Oesophagus

A = neg Chalasis = relaxation

It is a neuro-muscular disorder which is ch.ch. By:

1. Absence of peristalsis in the body of oesophagus.
2. High resting pressure of LOS more than 25mmgh.
3. Incomplete relaxation of LOS.
 Aetiology
 It is due to damage of the parasympathetic
innervation to the oesophagus.

 Central: vagal nucleus in brain stem.

 Peripheral: vagal fibers.

 Intramural: Aurbach’s plexus.

The exact cause of the neuro-pathology remains unknown

 Pathology

:
 2 segments can be recognized
1. Dilated tortous part above.
2. Narrow neck below.

 The elements of Auerbach’s plexus are defective

 Complications:
1. Oesophagitis.
2. Carcinoma 3%

.
Clinical picture

Sex: equal.
Age: young adult to late middle age.
 Dysphagia.
 Regurgitation.
 Chest pain
 Weight loss.
 Chest symptoms.
 Anaemia.
Investigatins

Barium meal Endoscopy Manometry

Treatment

Pneumatic dilation Cardiomyotomy

Gut. 2011 Feb 8
Richter JE, Boeckxstaens GE.
Temple University School of Medicine, Philadelphia, Pennsylvania, USA.

Over a two year horizon, the clinical success

of pneumatic dilation and laparoscopic
myotomy are comparable in a recent large
European randomised trial.
conclusion
 Classification of motility disorders of the
oesophagus.
 Achalasia is the commonest and it is due
damage of parasympathetic innervation to
the oesophagus. The cause of that is not
known.
 Clinical picture: Dysphagia and regurgitaion.
 Pre-cancerous 3%.
 Treatment: pneumatic dilation or
cardiomyotomy.