Achalasia

Achalasia is a motility disorder of the oesophagus, where there is a nerve degeneration in the Auerbach´s plexus, causing inability of the lower oesophageal sphincter in the cardia region (C) to relax. In oesophageal x-ray examinations a dilatation of the oesophagus is seen, and the contrast stays in the oesophagus for a long time. Endoscopy shows a quite normal cardia, and in less severe cases the endoscopic diagnose is not easy.

These pictures are from a patient with dysphagia for about two years, causing a weight loss of over 40 pounds. In advanced cases (which this is not), the dilatation of the oesophagus is quite marked.

Chagas´disease is an important differential diagnosis. This disease is caused by an infection with Trypanosoma cruzi and in this disease, the symptoms and x-ray findings are identical with classic achalasia. Chagas´ disease is common in some countries in Latin America.

In advanced cases the oesophagus is filled with food.

Pneumatic dilatation of the lower oesophageal sphincter is the most established treatment for achalasia and will result in a good response in about 70% of subjects. In subjects considered too high risk for pneumatic dilatation injection of botulinum toxin into the lower oesophageal sphincter may give acceptable results.

Pseudoachalasia:

causes of mechanical obstruction at the gastro-oesophageal junction (most commonly adenocarcinomas of the gastroesophageal junction) should be considered and investigated before diagnosing achalasia as these conditions may produce a similar clinical scenario named pseudoachalasia.