Achalasia of the esophagus  

Achalasia is characterized by:  

1. A hypertonic lower esophageal sphincter, which fails to relax in response to the swallowing wave  
2. Failure of propagated esophageal contraction, leading to progressive dilatation of the gullet. 

Cause: Associated with autoimmune diseases, such as 

1. type 1 diabetes mellitus, 
2. RA, SLE, Sjögren syndrome.
3. Ifectio: Chagas’ disease (Trypanosoma cruzi)

Clinical features: 

• Dysphagia, typically to solids and liquids. 
• Regurgitation, weight loss. 
• Chest pain due to esophageal spasm. 
• nocturnal pulmonary aspiration develops. 
• Squamous carcinoma of the esophagus. 

Investigations: 

Management 

• Pharmacological:

1. 1. CCB: nifedipine 
   2. S/L nitrates 

• Endoscopic 

1. 1. Forceful pneumatic dilatation 
   2. Injection of botulinum toxin (Endoscopically)
   3. Peroral endoscopic myotomy (POEM) 

• Surgical 

1. 1. Surgical myotomy (Heller’s operation) with partial fundoplication (antireflux procedure) 
   2. Followed by PPI therapy