Achalasia
Visual lesson on achalasia — the LES bodyguard, cancer crab, progressive food & drink, and the bird-beak sign.
Key Medical Facts
🦠 Diseases
Achalasia
Failure of the lower esophageal sphincter (LES) to relax, causing dysphagia to both solids AND liquids
The bouncer blocking the club entrance who won't let anyone in
Chagas Disease
Secondary achalasia caused by Trypanosoma cruzi (spread by kissing bug) damaging myenteric plexus
The bouncer's ridiculously big lips — 'kissing' clue for kissing bug
Pseudoachalasia
Achalasia-like picture caused by malignancy (mass effect or paraneoplastic effects)
The crab on a leash — cancer can CAUSE an achalasia-like syndrome
🫀 Anatomy
Lower Esophageal Sphincter (LES)
The muscular valve between esophagus and stomach; in achalasia, has increased resting pressure
The tight 'club entrance' at the end of the esophagus hallway
Myenteric (Auerbach) Plexus
Nerve network in esophageal wall containing inhibitory neurons that release NO + VIP to relax LES
The 'backstage managers' that tell the bouncer to relax
💡 Memory Aids
NO RELAX
Memory aid: the LES fails to relax in achalasia; also hints at loss of NO (nitric oxide)
The neon sign above the club door: 'NO RELAX! THE SPHINCTER CLUB'
💊 Drugs
Nitric Oxide (NO) & VIP
Inhibitory neurotransmitters that normally relax the LES; lost in achalasia due to neuron degeneration
VIP-badge-wearing guests being told 'NO!' by the bouncer
🤒 Symptoms
Progressive Dysphagia
Difficulty swallowing that worsens over time; in achalasia, affects BOTH solids and liquids (unlike mechanical obstruction)
Party crowd with burgers (solids) and drinks (liquids) — both get stuck
🔬 Diagnostics
Manometry
Shows increased LES resting pressure + absent/uncoordinated peristalsis — gold standard for diagnosis
The uncoordinated dancing crowd — no rhythm = no coordinated peristalsis
Bird's Beak Sign
Classic barium swallow finding: dilated esophagus tapering to narrow GE junction
Painter painting a white bird with long beak using 'BARIUM WHITE' paint
💉 Treatments
Botulinum Toxin (Botox)
Endoscopic injection to help LES relax — 'Botox for the bouncer'
Treatment to get past the bouncer — make him relax
Downloadable Assets
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