Achalasia

An oesophageal motor disorder characterised by a loss of oesophageal peristalsis and failure of the lower oesophageal sphincter to relax in response to swallowing.

The most common presenting symptoms are dysphagia to solids and liquids, regurgitation, and retrosternal pain. These can be slowly progressive over months or years.

The first investigation for any patient with dysphagia is endoscopy to exclude malignancy, but subsequent barium swallow studies and oesophageal manometry are usually required to establish the diagnosis of achalasia.

Treatment is symptomatic, not curative, and is primarily aimed at relieving dysphagia; options include pharmacological, endoscopic, and surgical procedures.

Achalasia, from the Greek for 'does not relax', is an oesophageal motor disorder of unknown aetiology, characterised by oesophageal aperistalsis and insufficient lower oesophageal sphincter (LOS) relaxation in response to swallowing. This results from loss of inhibitory nitrinergic neurons in the oesophageal myenteric plexus.