Pathophysiology of Achalasia

Area of Science:

• Gastroenterology
• Immunology
• Neurology

Background:

• Achalasia is a rare esophageal motility disorder affecting smooth muscle function.
• It involves abnormal lower esophageal sphincter relaxation and impaired esophageal peristalsis.

Purpose of the Study:

• To elucidate the pathophysiological mechanisms underlying achalasia.
• To highlight the role of autoimmune responses and other factors in its development.
• To emphasize the importance of accurate diagnosis for effective management.

Main Methods:

• Review of pathophysiological principles of esophageal motility.
• Analysis of causes for neuronal damage and inflammation in the esophagus.
• Correlation of clinical findings with esophageal function tests.

Main Results:

• The primary defect in achalasia stems from neuronal damage in esophageal plexuses, often due to autoimmune reactions post-viral infection.
• Viral infections (e.g., HSV, VZV, HPV, measles, COVID-19) can trigger molecular mimicry leading to neuronal injury.
• Other causes include Chagas disease, eosinophilic inflammation, neoplastic infiltration, and extrinsic compression.
• Chronic opioid use can also mimic achalasia symptoms.

Conclusions:

• Accurate diagnosis relies on thorough clinical assessment and interpretation of esophageal function tests.
• Understanding the pathophysiology guides treatment strategies for symptom relief.
• Effective management involves permanent disruption of malfunctioning esophageal smooth muscle.