Presentation, Diagnosis, and Management of Achalasia
Presentation, Diagnosis, and Management of Achalasia
The literal definition of achalasia is "failure of a ring muscle to relax." Despite this general definition, the term has been adopted to specifically describe esophageal achalasia, an entity also sometimes named cardiospasm or esophageal aperistalsis. Achalasia is characterized by impaired lower esophageal sphincter (LES) relaxation and aperistalsis in the distal esophagus. However, it is important to note that aperistalsis, also termed absent peristalsis, means that there is no progressively sequenced esophageal contraction; it does not imply the complete absence of intraluminal pressure. Consequently, absent peristalsis does not exclude the occurrence of spastic contractions or panesophageal pressurization. In fact, understanding these patterns of pressurization is the key to understanding the current classification scheme for achalasia and management of this disease.
Introduction
The literal definition of achalasia is "failure of a ring muscle to relax." Despite this general definition, the term has been adopted to specifically describe esophageal achalasia, an entity also sometimes named cardiospasm or esophageal aperistalsis. Achalasia is characterized by impaired lower esophageal sphincter (LES) relaxation and aperistalsis in the distal esophagus. However, it is important to note that aperistalsis, also termed absent peristalsis, means that there is no progressively sequenced esophageal contraction; it does not imply the complete absence of intraluminal pressure. Consequently, absent peristalsis does not exclude the occurrence of spastic contractions or panesophageal pressurization. In fact, understanding these patterns of pressurization is the key to understanding the current classification scheme for achalasia and management of this disease.