ESOPHAGUS : Achalasia


- Achalasia is a disease characterized by the absence of peristalsis in the body of the esophagus

- Three features are present in achalasia:
i) Aperistalsis of the esophagus
ii) Partial or incomplete relaxation of the lower esophageal sphincter with swallowing.
iii) Increased resting tone of the lower esophageal sphincter.

- Secondary features are proximal esophageal dilation, dysphagia, and regurgitation.
- Clinically, achalasia presents in young adulthood or earlier and is problematic throughout life.
- The risk of esophageal carcinoma is 2% to 7%.
- Other complications include candidial esophagitis, diverticula, and aspiration pneumonia.
- Manometry shows aperistalsis, impaired relaxation of the lower esophageal sphincter, and increased lower esophageal sphincter resting tone.

- Morphological features include the following: Image Link

i) Dilated esophagus above the lower esophageal sphincter.
ii) Thickened (muscular hypertrophy) or thinned (distention) muscular wall.
iii) Diminished myenteric ganglia.
iv) Secondary mucosal damage.

Secondary Achalasia:
- Secondary achalasia occurs with Chagas disease (Trypanosoma cruzi destroys ganglion cells),
- Disorders of the vagal dorsal motor nuclei (polio, surgical ablation),
- Diabetic autonomic neuropathy, and
- Infiltrative disorders (malignancy, amyloidosis, sarcoidosis).