ACHALASI

A
DE VILLA, CARINO, DHAKAL, GERBABUENA,
J I T T W A TA N A TA K O O L , J O R D A N , K A R N , K C

ACHALASIA
Means failure to relax
Motor disorder of the esophageal smooth muscle in
which the lower esophageal sphincter does not relax
normally with swallowing
Difficulties in swallowing both solid and liquid food

CAUSE
may be hereditary
may be caused by an autoimmune condition, where the
body attacks itself
Degeneration of nerves in the esophagus often
contributes to the advanced symptoms of the condition

SIGNS AND SYMPTOMS/ CLINICAL

FEATURES
Dysphagia (most common)
Regurgitation
Chest pain
Heartburn
Weight loss

MOTILITY OF THE
STOMACH
Functionally, the stomach can
be divided into the gastric
reservoir and the gastric pump

The gastric reservoir consists

of the fundus and corpus

The gastric pump is

represented by the area at
which peristaltic waves occur:
it includes the distal part of
the corpus and the antrum

Due to different properties of

the smooth muscle cells the
gastric reservoir is
characterised by tonic activity
and the gastric pump by pasic
activity

TONIC CONTRACTIONS
sustained contraction of a muscle, as employed in the
maintenance of posture

PHASIC CONTRACTIONS

MORPHOLO
GY
There is progressive dilation
of the esophagus above the
level of Lower Esophageal
Sphincter

The wall of the esophagus

may be of normal thickness,
thicker than normal owing to
hypertrophy of the
muscularis, or marked
thinned by dilation
The Myenteric Ganglia are
usually absent from the body
of esophagus, but may or
may not e reduced in number
in the region of the LES
The mucosal lining may be
unaffected, but sometimes
inflammation, ulceration, or
fibrotic thickening may be
evident above the LES

PATHOPHYSIOLOGY

DIAGNOSTIC PROCEDURE
ESOPHAGEAL MANOMETRY
involves having a tube placed in your esophagus while you
swallow
The tube records the muscle activity and makes certain
everything is working correctly

X-RAY OF ESOPHAGUS
may also be used to diagnose this condition

ENDOSCOPY
a small camera is put into the esophagus to look for problems

SUMMARY
FACTORS RESPONSIBLE FOR THE TONIC
CONTRACTION OF LES

CHOLINERGIC NERVES
MAJOR NEUROTRANSMITTERS RESPONSIBLE FOR
REGULATING CONTRACTION AND RELAXATION

ACETYLCHOLINE
VASOACTIVE INTESTINAL PEPTIDE
NITRIC OXIDE
ADENOSINE TRIPHOSPHATE