Achalasia

Clinic

• Esophageal achalasia, often referred to simply as achalasia, is a failure of smooth muscle fibers to relax, which can cause the LES (lower esophageal sphincter) to remain closed
• Achalasia can happen at various points along the gastrointestinal tract; Achalasia of the rectum, for instance, may occur in Hirschsprung's disease
• Achalasia characterized by
  1. Incomplete LES relaxation
  2. Increased LES tone
  3. Lack of peristalsis of the esophagus
  4. Absence of other explanations like cancer or fibrosis
• The most common form is primary achalasia, which has no known underlying cause. It is due to the failure of distal esophageal inhibitory neurons.
• However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease or Triple-A syndrome.
• Achalasia can also manifest alongside other diseases as a rare syndrome such as achalasia microcephaly.

Signs / Symptoms

• Achalasia is characterized by
  1. Dysphagia (difficulty in swallowing)
  2. Regurgitation of undigested food
  3. Sometimes Chest pain behind the sternum
• Dysphagia tends to become progressively worse over time and to involve both fluids and solids.
• Some people may also experience coughing when lying in a horizontal position.
• The chest pain experienced, also known as cardiospasm and non-cardiac chest pain can often be mistaken for a heart attack.
• It can be extremely painful in some patients.
• Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs (aspiration).
• Megaesophagus is end stage of Achalasia

Sign / Symptoms

• Dysphagia
• Eructation

Miasms

• HIV
• Chagas disease
• CMV: A case of documented esophageal dysmotility mimicking achalsia associated with CMV in a renal transplant patient is presented in 2009. Also we know the special coexistance of HIV and CMV. Another reason is the ducumented role of CMV in inducing Megacolon which indicate its ability in peristaltic Disturbance