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Excerpt from AchalasiaSynonyms, Key Words, and Related Terms: hypertensive nonrelaxed esophageal sphincter, primary esophageal motility disorder, lower esophageal sphincter, LES, esophageal peristalsis, dysphagia, regurgitation, chest pain, heartburn, weight loss Please click here to view the full topic text: AchalasiaBackgroundSir Thomas Willis described achalasia in 1672. In 1881, von Mikulicz described the disease as a cardiospasm to indicate that the symptoms were due to a functional problem rather than a mechanical one. In 1929, Hurt and Rake realized that the disease was caused by a failure of the lower esophageal sphincter (LES) to relax. They coined the term achalasia, meaning failure to relax. Achalasia is a primary esophageal motility disorder characterized by failure of a hypertensive LES to relax and the absence of esophageal peristalsis. These abnormalities cause a functional obstruction at the gastroesophageal junction. PathophysiologyLES pressure and relaxation are regulated by excitatory (eg, acetylcholine, substance P) and inhibitory (eg, nitric oxide, vasoactive intestinal peptide) neurotransmitters. Persons with achalasia lack nonadrenergic, noncholinergic, inhibitory ganglion cells, causing an imbalance in excitatory and inhibitory neurotransmission. The result is a hypertensive nonrelaxed esophageal sphincter. FrequencyUnited StatesThe incidence of achalasia is approximately 1 per 100,000 people per year. InternationalChagas disease may cause a similar disorder. SexThe male-to-female ratio of achalasia is 1:1. AgeAchalasia typically occurs in adults aged 25-60 years. Fewer than 5% of cases occur in children. Please click here to view the full topic text: Achalasia |
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