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Related Concept Videos

Esophageal Achalasia01:27

Esophageal Achalasia

Esophageal achalasia is a chronic neurogenic disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and absent or ineffective peristalsis in the distal esophagus. This leads to a functional obstruction without a physical blockage, despite significant disruption of esophageal motility.EtiologyAchalasia is caused by degeneration of the myenteric (Auerbach's) plexus, specifically the loss of inhibitory ganglion cells that produce vasoactive intestinal peptide (VIP)...
Assessment of the Rectum and Anus01:25

Assessment of the Rectum and Anus

Evaluating the rectum and anus plays a crucial role in conducting a thorough physical examination of the gastrointestinal system. Although it may be uncomfortable and often embarrassing for the patient, it holds immense diagnostic value, particularly in detecting gastrointestinal diseases and abnormalities. This guide will explain how to perform this assessment using inspection and palpation methods.
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
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Inflammatory Bowel Disease V: Surgical Management

Surgical interventions for inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease, are essential in managing symptoms and addressing complications. The selection of surgical procedures is contingent upon the specific conditions and complications that stem from these illnesses.
Here are some common surgical interventions for IBD:
Gastrointestinal Motility Disorders01:20

Gastrointestinal Motility Disorders

Gastrointestinal or GI motility disorders are characterized by irregular gastrointestinal tract movements, disrupting food transit from the mouth to the anus. They are caused by damage or dysfunction in gut muscles or nerves. These disorders can cause symptoms such as severe constipation, diarrhea, abdominal pain, and swallowing difficulties. Disorders can affect any segment of the GI tract and range widely in severity, from common conditions like GERD to life-threatening conditions like...
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Related Experiment Video

Updated: Jun 20, 2026

Robotic Myotomy and Partial Fundoplication for Achalasia
11:19

Robotic Myotomy and Partial Fundoplication for Achalasia

Published on: August 11, 2023

Internal anal sphincter achalasia.

Reshma Doodnath1, Prem Puri

  • 1Children's Research Centre, Our Lady's Children's Hospital, and UCD Conway Institute of Biomolecular and Biomedical Research, UCD School of Medicine, Dublin, Ireland.

Seminars in Pediatric Surgery
|September 29, 2009
PubMed
Summary

Internal anal sphincter (IAS) achalasia, a condition mimicking Hirschsprung

Area of Science:

  • Gastroenterology and Colorectal Surgery

Background:

  • Internal anal sphincter (IAS) achalasia presents similarly to Hirschsprung's disease but with present ganglion cells on biopsy.
  • Pathogenesis is multifactorial, involving neurogenic mechanisms like absent nitrergic innervation and altered interstitial cells of Cajal.

Purpose of the Study:

  • To review the diagnostic methods and treatment options for internal anal sphincter achalasia.
  • To discuss the efficacy of current and emerging treatments for IAS achalasia.

Main Methods:

  • Diagnosis relies on anorectal manometry showing absence of the rectosphincteric reflex.
  • Rectal suction biopsy confirms the presence of ganglion cells, differentiating it from Hirschsprung's disease.

Main Results:

  • Anorectal manometry is key for diagnosing IAS achalasia by identifying the lack of rectosphincteric reflex.

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  • Posterior IAS myectomy is the established treatment, while botulinum toxin injections are an emerging option.

    • Conclusions:

    • IAS achalasia requires specific diagnostic criteria, including manometry and biopsy findings.
    • While posterior IAS myectomy remains the gold standard, botulinum toxin offers a less invasive alternative requiring further long-term evaluation.