{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 2, Ep 2 of 4: Achalasia","html":"<iframe width=\"100%\" height=\"180\" frameborder=\"no\" scrolling=\"no\" seamless src=\"https://share.transistor.fm/e/5036d0a1\"></iframe>","width":"100%","height":180,"duration":702,"description":"Achalasia is where the manometry numbers point most often, and every strange feature of the disease falls out of one lesion: loss of the inhibitory nerves that relax the sphincter and time the wave. The sphincter clamps but never releases, the body loses its wave, and what the body does on those failed swallows names the subtype. Subtype picks treatment because it changes what the procedure has to accomplish.\n \nTopics covered\n\nOne lesion: inhibitory nerve loss, excitatory nerves spared\nDysphagia to solids and liquids from the start\nThree subtypes as three ways a wave-less body behaves\nEGD first as a rule-out, not a rule-in\nBird-beak on barium, IRP and subtype on manometry\nNo treatment fixes the muscle: all lower sphincter pressure\nBotox, dilation, Heller, POEM tradeoffs\nOpioids and pseudoachalasia as framework-breaking traps\n \n \nKey decisions\n\nDysphagia to solids AND liquids from onset points to a failed wave, not a physical narrowing\nA normal-looking endoscopy does not exclude achalasia: up to 40 percent look clean\nType two (pan-esophageal pressurization) has the best prognosis and responds to every treatment\nType three needs a long myotomy reaching the spastic segment, so POEM; pneumatic dilation is the wrong answer\nNever Botox a healthy young surgical candidate: it scars the plane and raises later myotomy perforation risk\nAvoid a full fundoplication after Heller: a wave-less esophagus cannot push through a complete wrap\nChronic opioids can mimic type three or spasm; stop the drug and repeat manometry before any procedure\nAge over 60, short history, and disproportionate weight loss mean rule out pseudoachalasia with EUS and cross-sectional imaging\n \n \nThis is an AI-generated podcast, and some pronunciations may be imperfect. Thank you for your understanding, and we hope you enjoyed this content.\n \n \nStudy the full chapter on Board Pearls, with practice questions, tables and primary-guideline references: Esophageal Motility\nRead this episode:...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}