Vnitr Lek 2005, 51(6):704-713

Esophageal achalasia

E. Veseliny^*, T. Hildebrand, P. Jarčuška, M. Zakuciová

I. interná klinika Lekárskej fakulty UPJŠ a FNsP, Košice, Slovenská republika, prednosta prof. MUDr. Ivica Lazúrová, Ph.D.

Achalasia is a well-recognized primary esophageal motor disorder of unknown etiology. It is characterized by incomplete lower esophageal sphincter (LES) relaxation and aperistalsis of the esophageal body. These abnormalities are thought to result from frequently observed neuropathic changes involving a loss of inhibitory ganglionic cells of myenteric plexus in the LES and in the esophageal body. The pathogenesis of idiopathic achalasia is unknown. Available data suggest hereditary, degenerative, autoimmune, and infectious factors as possible causes for achalasia, the latter two being the most commonly accepted. The diagnosis of achalasia should be suspected in anyone complaining of dysphagia for solids and liquids with regurgitation of food and saliva. The clinical suspicion should be confirmed by a barium esophagram showing smooth tapering of the distal esophagus leading to the closed LES, resembling a "bird's beak". Esophageal manometry establishes the diagnosis showing insufficient LES relaxation and esophageal aperistalsis. All patients should undergo upper endoscopy to exclude pseudoachalasia. Although there is no cure for achalasia, the goal of treatment should be relief of patient symptoms and improved esophageal emptying. The two most effective treatment options are graded pneumatic dilation and surgical myotomy. For patients who are at high risk for pneumatic dilation or surgery, endoscopic injection of the LES with botulinum toxin may be acceptable alternative.

Keywords: achalasia; pneumatic dilation; Heller myotomy; botulinum toxin

Received: October 18, 2004; Accepted: December 1, 2004; Published: June 1, 2005  Show citation