Achalasia: A Review of Etiology, Pathophysiology, and Treatment

Nor Hedayanti,Supriono Supriono

doi:10.24871/171201632-37

Abstract

Achalasia was a condition marked by peristaltic movement absent in lower esophageal sphincter and segment that hypertonic result in imperfect relaxation during food ingestion. Achalasia incidence did not differ between men and women, account for 1 in 100.000 people every year with prevalence of 10 in 100.000 people, unrelated specifically with ethnic, and has its highest incidence on 30-60 age group.Based on its etiology, it was divided into primary and secondary Achalasia, while based on its motility, it was into hypermotil, hypomotil, and amotil Achalasia. Until present, several therapeutic modalities were available to treat Achalasia, among them was pharmacology therapy, botulinum toxin injection via endoscopy, pneumatic dilatation, Heller myotomy surgery, and Per Oral Endoscopy Myotomy (POEM).

Highlights

Based on its etiology, it was divided into primary and secondary Achalasia, while based on its motility, it was into hypermotil, hypomotil, and amotil achalasia
Some Literatures said that Achalasia was a primary GLVRUGHU RI HVRSKDJXV ZLWK UHOD[DWLRQ LQVXI¿FLHQF\ of lower esophageal sphincter as its etiology, with
per oral endoscopy myotomy (POEM) is a technique involving tunneling between esophageal muscle to treat achalasia, especially with Chagas disease

Summary

INTRODUCTION

$FKDODVLDZDV¿UVWO\GHVFULEHE\6LU7KRPDV:LOOLV in 1674 after he use whale bone to dilate his patients esophagus because of lower esophageal sphincter relaxation failure. Achalasia was progressive idiopathic neural degeneration of Auerbach myenteric plexus, result in food static during ingestion and esophagus dilatation This condition will lead to several symptoms and complication, depend on its severity and duration.[1,2] Some Literatures said that Achalasia was a primary GLVRUGHU RI HVRSKDJXV ZLWK UHOD[DWLRQ LQVXI¿FLHQF\ of lower esophageal sphincter as its etiology, with. In Gastroentero-hepatology division, Internal Medicine Department, Faculty of Medicine, University of Indonesia/Dr Cipto Mangunkusumo Hospital, 48 cases was found during 5 years period (1984-1988), mostly with the same age groups.2,3Achalasia was not a rare condition This could be seen in middleaged population, clinically marked with dysphagia, regurgitation, and epigastric discomfort. Endoscopy procedure to see gastroesophageal junction and gastric cardia was recommended in all patients with Achalasia to eliminate the possibility of pseudoachalasia.3If irreveribe functiona disorder happened, the main therapy for Achalasia was palliative treatment. Sphincter does not relax, so that the condition called Achalasia happened.[4]

CLINICAL MANIFESTATION

There were several diagnostic modalities to evaluate

Endoscopic Botolium Toxin Injection

Pneumonic Dilatation

Findings

CONCLUSION