achalázii

Achalasia is a rare esophageal motility disorder characterized by the failure of the lower esophageal sphincter to relax properly and the absence of normal peristalsis in the esophageal body. The term "achalasia" comes from Greek words meaning "failure to relax." This condition leads to difficulty swallowing both solids and liquids, a sensation of food getting stuck in the chest, and regurgitation of undigested food. Chest pain, heartburn, and unintentional weight loss can also occur.

The exact cause of achalasia is not fully understood, but it is believed to involve damage to the nerves in the esophagus, particularly the inhibitory neurons in the myenteric plexus. This damage can lead to a loss of the coordinated muscle contractions that move food down into the stomach and the failure of the sphincter to open. While achalasia can occur at any age, it is most commonly diagnosed in adults between the ages of 25 and 60.

Diagnosis typically involves a combination of tests. An upper endoscopy allows visualization of the esophagus and can rule out other conditions. Barium swallow studies show the characteristic bird's beak appearance of the lower esophagus due to the narrowed opening. Esophageal manometry is the gold standard, measuring pressures within the esophagus and lower esophageal sphincter to confirm the lack of peristalsis and relaxation.

Treatment aims to relieve symptoms by improving the passage of food from the esophagus to the stomach. Options include pneumatic dilation, which stretches the lower esophageal sphincter, myotomy, a surgical procedure to cut the muscle fibers of the sphincter, and medications like calcium channel blockers or nitrates, which can help relax the muscle, though these are generally less effective for long-term management. Botulinum toxin injection into the sphincter is another option, particularly for patients who are not candidates for surgery or dilation. While these treatments can alleviate symptoms, they do not cure achalasia.