A 41-year-old man complaints of regurgitation of saliva

Discussion in 'MRCS Forum' started by Vinay., Mar 26, 2008.

  1. Vinay.

    Vinay. Guest

    A 41-year-old man complaints of regurgitation of saliva and of ingested but undigested food. An esophagram reveals a birds-beak deformity. Which of the following statements is true about this condition?

    a- Chest pain is common in the advanced stages of this disease
    b- More patients are improved by forceful dilatation than by surgical intervention
    c- Manometry can be expected to show high resting pressures of the lower esophageal sphincter
    d- Surgical treatment primarily consists of resection of the distal esophagus with reanastomosis to the stomach above the diaphragm
    e- Patients with this disease are at no increased risk for the development of carcinoma
  2. Vinay.

    Vinay. Guest

    Answer: c. (Schwartz, 7/e, pp 1126-1137) Patients with achalasia typically present with distal esophageal obstruction, which leads to regurgitation of saliva and undigested food. The characteristic appearance of the esophagram is the tapered birds-beak deformity at the level of the esophagogastric junction. Chest pain may be seen in the early stages of the disease. Manometry yields high resting pressures of the lower esophageal sphincter, which fails to relax or only partially relaxes. The absence of peristaltic deglutitory contractions in the body of the esophagus is also noted during manometry. Although both surgical intervention and forceful dilatation have been used to treat this disease, surgery results in improvement in over 90% of patients, compared with only 70% of patients treated by forceful dilatation. Surgical treatment is an esophagomyotomy. Patients with achalasia have 7 times the risk of developing squamous cell carcinoma as the general population. This dreaded complication can occur even after successful for the disease.

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