GASTROENTEROLOGY ARTICLE OF THE WEEK
September 9, 2010
Francis DL, Katzka DA. Achalasia: Update on the disease and its treatment. Gastroenterology 2010;139:369-374.
1. Which of the following manometric findings are required to establish a diagnosis of achalasia
a. Intermittent peristalsis
b. hypertensive LES
c. No LES relaxation
d. Incomplete LES relaxation
e. lack of peristalsis
2. Which of the following pathophysiologic features are found in achalasia
a. fibrosis of the LES
b. degeneration of the myenteric plexus
c. PCR evidence of Herpes-1 infection in most patients
d. Depletion of nitric oxide in the LES leading to hypertonicity and loss of relaxation
e. Ganglion cell degeneration associated with inflammatory infiltration of the LES
True or False
3. Botulinum toxin injection in the LES region helps LES relaxation by increasing Nitric Oxide concentration in the area
4. Patients with megaesophagus (>6cm in diameter) are less likely to do well with Heller myotomy
5. Risk for squamous cell carcinoma of the esophagus is increased only in patients with untreated achalasia, treatment abolishes risk
6. Patients with more severe symptoms from achalasia are more likely to have the most pronounced abnormalities during a barium swallow examination
7. For patients with an operative risk of 0.7% or less, laparoscopic Heller Myotomy is the preferred modality to treat achalasia
8. A patient with new onset achalasia at age 65 probably has cancer, as idiopathic achalasia rarely arises at that age
9. Anti-Hu antibodies may be associated with paraneoplastic achalasia
10. The most common cause of secondary achalasia is Chaga’s disease
11. Results of pneumatic dilation are longer lasting and more satisfactory than results obtained with botulinum toxin injection