ACHALASIA

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DEFINITION: A common historical definition of achalasia is the inability of the lower esophageal sphincter to relax in the set- ting of absent peristalsis. Achalasia should be considered, especially in the setting of dysphagia primarily to liquids.

PATHOSIOLOGY: Achalasia is associated with functional loss of myenteric plexus ganglion cells in the distal esophagus and lower esophageal sphincter.26 The cause for an initial reduction of inhibitory neu- rons in achalasia is unknown. Initiation of neuronal degeneration may be an autoimmune process triggered by an indolent viral infection (herpes, measles) in conjunction with a genetically susceptible host