Other Oesophageal Conditions (Achalasia, Eosinophilic Oesophagitis)

Achalasia

This is a motor disorder, characterised by a loss of oesophageal peristalsis and failure of the LOS to relax in response to swallowing, therefore leading to a build-up of food/fluids at the bottom of the oesophagus. This is due to a loss of inhibitory nitrinergic neurons in the oesophageal myenteric plexus.

It presents with progressive dysphagia, regurgitation, and retrosternal chest pain. A differential of oesophageal cancer is warranted, therefore requiring investigations to rule it out.

Investigations:

• Endoscopy to exclude malignancy

• Barium swallow and oesophageal manometry for diagnosis

Management:

• Nitrates (e.g. Isosorbide dinitrate) or CCB before meals

• Oesophageal dilatation

• Cardiomyotomy (Heller procedure) - Vertical cut made in muscle layer of the lower oesophagus, leaving the inner lining intact. As this procedure is often complicated by reflux afterwards, fundoplication is usually performed at the same time to minimise this.

Eosinophilic Oesophagitis

This is a chronic, immune-mediated/allergen-mediated condition defined clinically by symptoms of oesophageal dysfunction, and pathologically by an eosinophilic infiltration of the oesophageal epithelium in the absence of secondary causes of local/systemic eosinophilia.

It’s more commonly seen in children and young adults, presenting with:

• Dysphagia and food impaction

• Regurgitation, vomiting, heartburn, abdominal pain,

• Failure to thrive or feeding intolerance in children

Investigations:

• OGD - linear furrows, oedema, mild white plaques, and narrowing

• Oesophageal biopsy

Management:

• Oral corticosteroids or PPI’s

• Dietary elimination

• Oesophageal dilatation for those with strictures or fibrostenotic complications