Which of the following statements about achalasia is correct?
ExplanationIn South America, infestation by the parasite T. cruzi causes a condition (Chagas’ disease) that is clinically indistinguishable from achalasia. In Europe and North America, the cause of achalasia is largely unknown. The commonest presenting symptoms are dysphagia, regurgitation (indigested food) and weight loss. Chest pain is uncommon and heartburn is not a feature, as acid reflux does not occur against a closed sphincter. As such, patients do not develop Barrett’s oesophagus. However, achalasia is regarded as a pre-malignant condition with a small risk of oesophageal cancer (squamous cell and adenocarcinoma), usually after 20 years. The classic manometric findings of achalasia are failure of relaxation of the lower oesophageal sphincter on swallowing and absent or weak simultaneous contractions in the oesophageal body after swallowing. POEM is a new endoscopic technique that is performed in very specialised units and has not replaced the more established treatment modalities of pneumatic dilatation, endoscopic botulinum toxin injection of the lower oesophageal sphincter and surgery (Heller’s myotomy).
