ACHALASIA
PRESENTED BY CHARITY BANDA BSc 4TH YEAR
STUDENT UNZA
INTRODUCTION
Achalasia is a disorder of the
oesophagus where it loses the ability
to move food along. The valve at the
end of the oesophagus also fails to
open and allow food to pass into the
stomach
CONT’
 As a result, food gets stuck in the
esophagus and is often brought back
up. A ring of muscle called the lower
esophageal (cardiac) sphincter
keeps the opening from the
esophagus
CONT’
to the stomach shut tight to prevent
Acid reflux (acidic stomach content
moving back up into the
oesophagus).Normally, this muscle
relaxes when you swallow to allow the
food to pass into the stomach
CONT’
 In achalasia, this muscle does not
relax properly and the end of the
oesophagus becomes blocked with
food. It is sometimes known as cardio
spasm
OBJECTIVES
GENERAL OBJECTIVE
At the end of the lecture / discussion,
students should be able to manage
patients with achalasia
CONT'
SPECIFIC OBJECTIVES
At the end of the lecture / discussion,
students should be able to
Define achalasia
State the cause of achalasia
CONT’
Explain the pathophysiology of
achalasia
State the Signs and symptoms of
Achalasia
Describe the management of
patients with achalasia
CONT’
Explain the signs & symptoms of
achalasia
Describe the management of
patients with achalasia
DEFINITION
Achalasia is a disorder of the
oesophagus that prevents normal
swallowing as a result of failure of the
lower oesophageal sphincter to relax
allowing food to enter the stomach
characterised by dysphagia, chest
pain, heartburn, regurgitation and
chest pains. Miller,(2003)
ETIOLOGY
The exact cause of achalasia is poorly
understood. Researchers suspect it
may be caused by a loss of nerve
cells in the esophagus. There are
theories about what causes this, but
viral infection or autoimmune
responses have been suspected.
CONT’
Very rarely, achalasia may be
caused by an inherited genetic
disorder or infection.
PATHOPHYSIOLOGY
 Achalasia is an inflammatory disease
of unknown etiology characterized
by esophageal aperistalsis and failure
of LES relaxation due to loss of
inhibitory nitrinergic neurons in the
esophageal myenteric plexus.
CONT’
Proposed causes of achalasia include
gastroesophageal junction obstruction,
neuronal degeneration, viral infection,
genetic inheritance, and autoimmune
disease.
CONT’
Current evidence suggests that the
initial disturbance to the esophagus,
perhaps a viral infection or some
other environmental factor, results in
myenteric plexus inflammation.
CONT’
Inflammation then leads to an
autoimmune response in a susceptible
population who may be genetically
predisposed. Subsequently, chronic
inflammation leads to destruction of
CONT’
the inhibitory myenteric ganglion cells
resulting in the clinical syndrome of
idiopathic achalasia. Park, (2005)
SIGNS AND SYMPTOMS
Achalasia symptoms generally
appear gradually and worsen over
time.
Inability to swallow (dysphagia),
which may feel like food or drink is
stuck in your throat
CONT’
Regurgitating food or saliva
Heartburn
Belching
Chest pain that comes and goes
Coughing at night
CONT’
Pneumonia (from aspiration of food
into the lungs)
Weight loss
Vomiting
MEDICAL AND SURGICAL MANAGEMENT
DIAGNOSIS
Oesophageal Manometry: Measures
the rhythmic muscle contraction in the
Medication
Muscle relaxants: May be given orally
or injected (Botox) directly to the
oesophageal sphincter.
CONT’
PROCEDURES
Pneumatic dilation: A balloon is
inserted into esophageal sphincter
and inflated. This treatment is usually
required to be repeated in about 6
years.
CONT’
Heller myotomy: Muscle at the lower
end of esophagus sphincter is cut
down to facilitate the passage of
food along the oesophagus into the
stomach to check how well it relaxes
when required.
CONT’
Barium swallow: A chalky liquid that
coats and fills the inside lining of
digestive tract is given, followed by
an X-ray of the upper digestive
system is performed.
CONT’
Endoscopy: A small, thin and flexible
tube attached to the camera is
inserted down the throat to check
the inside of oesophagus and
stomach.
CONT’
Biopsy: Removal of tissue from the
lower oesophageal sphincter to
check for any hypertrophied
musculature and absence of nerve
fibres.
CONT’
Treatment options are all directed at
relieving the stasis caused by
increased lower oesophageal
sphincter (LES) pressure, non-relaxing
LES and a peristaltic Oesophagus
CONT’
Nissen fundoplication: Top of the
stomach is wrapped to tighten
muscles and prevent acid reflux.
CONT’
Per-oral Endoscopic Myotomy: A tube
is inserted through the mouth and an
incision is made at the sphincter region
to improve the passage of food into
the stomach., if necessary an
oesophagostomy can be performed
CONT’
Self-care
Chew the food well.
Consume plenty of fluids with meals.
Do not go to bed immediately after
a meal.
CONT’
Eat more frequent, smaller meals.
 Give the patient a semisoft bland
diet and let him eat slowly and drink
fluid with meals
Sleeping with the head elevated
CONT’
NUTRITION
Take soft, easy to swallow foods like
soup, mashed vegetables or porridge.
Protein rich foods like chicken, soya,
and fish
CONT’
Ginger can also help in improving
digestion and help in reducing
heartburn.
CONT’
Foods to avoid:
Avoid citrus foods and foods that are
rich in caffeine.
Avoid spicy and fried foods
CONCLUSION
 Achalasia is an esophageal motor
disorder characterized by a loss of
esophageal peristalsis and failure of
the lower esophageal sphincter to
relax in response to swallowing
CONT’
The most common presenting
symptoms are dysphagia to solids and
liquids, regurgitation, and retrosternal
pain.
ASSIGNMENT
Identify five problems that a patient
with achalasia has and manage
them using a nursing care plan.
To be submitted next week Thursday.
REFERENCES
Harkness, A. G., and Dincher, R,
J.,(1999), MEDICAL SURGICAL
NURSING: TOTAL PATIENT CARE, 10th
Edition, Mosby, Mousori
Long, B, C.,(1993),MEDICAL
SURGICAL NURSING: A NURSING
CARE APPROACH,3rd Edition, Mosby,
Mousori
CONT’
Smeltzer, S. C., and Bare, B., (2004),
MEDICAL SURGICAL NURSING, 10th
Edition. Lippincott Williams and
Wilkins, Hong Kong
CONT’
Miller-Keane Encyclopedia and
Dictionary of Medicine, Nursing, and
Allied Health, Seventh Edition. (2003).
Retrieved August 6 2022
from https://medicaldictionary.thefreedictionary.com
CONT’
Park, Woosuk M.D.; Vaezi, Michael F.
M.D., Ph.D.. Etiology and
Pathogenesis of Achalasia: The
Current Understanding. American
Journal of Gastroenterology: June
2005 - Volume 100 - Issue 6 - p 14041414