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Achalasia

Use this section to learn about achalasia and:

What is Achalasia?

Achalasia is a disease of the myenteric plexus (the nerves around the esophagus) that affects the function of the esophageal body and the lower esophageal sphincter (the valve between the esophagus and stomach).

Achalasia is characterized by failure of the esophageal body peristalsis (the motion of the esophagus that pushes food toward the stomach) and by failure of relaxation of the lower esophageal sphincter (the valve between the esophagus and the stomach does not relax or open up).

When the esophagus cannot function well to push the food toward the stomach and the lower esophageal sphincter cannot relax or open, the food cannot pass form the esophagus to the stomach. Learn about the symptoms.

Who Suffers from Achalasia?

Achalasia is present in one to three per 100,000 persons in the Western world and most commonly affects individuals between the ages of 20 and 40 years.

What Happens if Achalasia is Untreated?

If left untreated, persistent achalasia may cause the esophagus to become dilated (enlarged) and eventually stop functioning. Patients with untreated achalasia have higher chances of developing esophageal cancer (squamous cell carcinoma).

How is Vigorous Achalasia Different?

In patients with vigorous achalasia, the esophageal contractions have very high pressure. These patients have simultaneous esophageal contractions (they all happen at the same time). Plus, the lower esophageal sphincter does not open.

Patients with vigorous achalasia have similar symptoms to patients with achalasia. In addition, they may have severe chest pain due to the elevated pressure in the esophageal body. The evaluation and treatment of these patients is the same as patients with achalasia.

By Farzaneh Banki, M.D.

References

1. Lyass S, Thoman D, Steiner JP, et al. Current status of an antirefluxprocedure in laparoscopic Heller myotomy. Surg Endosc. 2003;17:554 –558.
2. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405– 412; discussion 412–415.
3. Zaninotto G, Annese V, Costantini M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg. 2004;239: 364 –370. 4. Ruffato A, Mattioli S, Lugaresi ML, et al. Long-term results after Heller-Dor operation for oesophageal achalasia. Eur J Cardiothorac Surg. 2006;29: 914–919.
5. Guilherme M. Campos, MD, PhD, Eric Vittinghoff, PhD, Charlotte Rabl, MD, Mark Takata, MD, Michael Gadenstatter, MD, Feng Lin, MS, and Ruxandra Ciovica, MD, Endoscopic and Surgical Treatments for Achalasia, A Systematic Review and Meta-Analysis. Ann Surg, Volume 249, Number 1, January 2009:45-57