Achalasia

Achalasia 

Updated: 02/12/2021

© Jun Wang, MD, PhD

General features
  • Lack of progressive peristalsis and partial/incomplete relaxation of lower esophageal sphincter (LES)
  • Preferentially involves circular layer of muscularis propria, which is hypertrophied
  • Markedly higher risk for squamous cell carcinoma
  • Higher risk for aspiration, Barrett's esophagus, Candida infection, gastroesophageal reflux, lower esophageal diverticula, peptic ulceration, stricture
Etiology
  • Primary: T cell mediated destruction or complete absence of myenteric ganglion cells in lower third of esophagus
  • Secondary: Allgrove‘s syndrome, amyloidosis, Chagas' disease, diabetic autonomic neuropathy, polio, sarcoidosis, surgical ablation of dorsal motor nuclei, thyroid disease, tumor
Clinical presentations
  • Dysphagia (most common), regurgitation, chest pain, heartburn, weight loss
Diagnosis
Treatment
  • Goal of therapy: Relieve symptoms
  • Pharmacologic and other nonsurgical treatments: Calcium channel blockers, nitrates; endoscopic intrasphincteric injection of botulinum toxin
  • Surgical treatment: Laparoscopic Heller myotomy; peroral endoscopic myotomy
  • If surgery fails: Endoscopic dilatation
  • Esophagectomy: Last resort



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