MAHE 2006 Achalasia
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- lower esophageal sphincter
Failure of relaxation of LES
Achalasia is a neuromuscular failure of relaxation at the lower end of the oesophagus with progressive dilatation, tortuosity, incoordination of peristalsis and often hypertrophy of the oesophagus above. There is effectively a functional obstruction at the lower end of the oesophagus.
Achalasia may occur at any age but particularly in the third to fourth decades. Males and females are affected equally.
Incidence is about 1 per 100,000 per year.
Achalasia primarily involves a neurological defect involving the ganglion cells of Auerbach's myenteric plexus in the lower oesophageal sphincter and oesophageal body. Abnormalities have also been reported in the vagal dorsal motor nucleus, the nucleus ambiguus, and in the smooth muscle of the oesophagus.
The damaging agent has been variously hypothesised as a neurotoxic virus, an autoimmune process, and a vitamin deficiency; none has been conclusively demonstrated.
At its most severe, aperistalsis occurs in the lower two thirds of the oesophagus with normal peristalsis above it. Thus, food accumulates in the oesophagus which then becomes dilated and atonic. The prolonged transit time may be a factor in the increased incidence of malignancy with achalasia - in up to 5% of cases.
It closely resembles changes seen in Chagas' disease.
Category: MAHE 2006 MCQs
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