Wednesday, May 31, 2017

Step 2 CK: Manometric findings of achalasia and scleroderma

In achalasia:
Basal LES pressure - Increases / decreases?
Peristalsis - Increases / decreases?

In scleroderma:
Basal LES pressure - Increases / decreases?
Peristalsis - Increases / decreases?

This is high yield for CK!
The manometric criteria for a diagnosis of achalasia should include the following, in decreasing importance:
1. Absence of peristalsis in the distal esophagus.
2. Incomplete relaxation of the LES.
3. Elevated resting LES pressure, defined in our laboratory as greater than 45 mm Hg.

Achalasia is not the only cause of aperistalsis. Severe peristaltic failure and complete aperistalsis may also be seen in patients with connective issue diseases such as scleroderma, amyloidosis, and diabetes mellitus, and in reflux disease.

However, in such patients, these findings can be differentiating:
1. Basal LES pressure is typically very low
2. LES relaxation is complete
3. No increase in basal intraesophageal pressure

That's all!

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