Gastro: Achalasia: Free MSRA Podcast

🎧 FREE MSRA PODCAST – Achalasia:Swallowing Troubles UnlockedInthis MSRA podcast episode, we take a deep dive into Achalasia, a rare but important oesophageal motility disorder.We'll help you recognise red flag symptoms,understand how it’s diagnosed, andremember key treatment options like Heller’s myotomy and POEM — all based on UK NICEguidance. If you're preparing for the Gastro MSRA section, this one'sessential. 🧠 Key Learning Points 📌 Definition•Achalasia is a primary oesophageal motilitydisorder characterised by: –Failure of the lower oesophageal sphincter (LOS)to relax, and –Loss of peristalsis in the distaloesophagus.•Result: Functional obstruction, notstructural. 📌 Pathophysiology•Due to degeneration of the myenteric(Auerbach’s) plexus.•Loss of inhibitory neurotransmitters (e.g. nitricoxide, VIP) leads to sustained LOScontraction.•Balance shifts towards excitatoryneurotransmitters (e.g. acetylcholine).•Rare causes: Chagas disease, secondaryachalasia from malignancy. 📌 Mnemonics•D-R-C-A-R-E-W = Symptoms of achalasia: –Dysphagia (solids + liquids) –Regurgitation of undigested food –Chest pain –Aspiration (nocturnal cough, pneumonia) –Reflux symptoms –Early satiety / emptying difficulty –Weight loss 📌 Epidemiology•Rare: ~1 in 100,000 prevalence•Equal in males and females•Peak onset: 25–60 years 📌 DiagnosisGold standard:  – Oesophageal manometry  • Raised LOS pressure   • Incomplete relaxation   • Absent peristalsisBarium swallow:  – Classic “bird’s beak” sign at gastro-oesophageal junction  – Dilated, tortuous oesophagus with smooth taperingEndoscopy:  – Rules out malignancy (pseudoachalasia)  – May show retained food/fluid 📌 Management Options•M-B-S-B mnemonic: –Medical: Nitrates or CCBs (limited,short-term use) –Balloon dilation: Pneumatic dilatation ofLOS (risk: perforation) –Surgery:  •Laparoscopic Heller’s myotomy (often withfundoplication)  •POEM: Peroral endoscopic myotomy(minimally invasive) –Botox injections: For frail patients,short-lived benefit (6–12 months) 📌 Complications•Aspiration pneumonia•Weight loss/malnutrition•Oesophageal cancer – especially squamous cell carcinoma –Risk up to 15x higher•Psychological impact (e.g. depression)•Recurrence or reflux post-treatment 📌 Key Differentials•Oesophageal cancer (pseudoachalasia)•Chagas disease•Benign strictures•Severe GORD•Scleroderma (involves LOS hypotonia)•Oesophageal spasm 📌 Summary Recap•Achalasia = functional obstruction due toLOS dysfunction + loss of peristalsis•Think dysphagia to solids and liquids,regurgitation, chest pain•Investigate with barium swallow, endoscopy, and confirm with manometry•Manage with dilation, surgery, Botoxdepending on the patient•Monitor long-term for cancer risk and recurrence 📎 More MSRA Resources for Achalasia📝 Revision Notes:https://www.passthemsra.com/topic/achalasia-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/achalasia-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/achalasia-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/achalasia-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/gastroenterology-for-the-msra/ Hashtags#MSRA#MSRARevision #AchalasiaMSRA #GastroMSRA #Manometry #HellerMyotomy #BirdsBeak#MSRAFlashcards #MSRAQuiz #MedicalEducation