Abstract
Achalasia is an uncommon motility disorder of the esophagus that is characterized by impaired lower esophageal sphincter (LES) relaxation and, in many cases, failure of peristalsis. Although the cause is unknown, it is thought to arise from the loss of myenteric neurons in the esophagus from an aberrant immune response in a genetically susceptible host. The resultant stasis of ingested food results in dysphagia, chest pain, and weight loss. The Chicago Classification for High Resolution Manometry (HRM) has categorized patients with achalasia into three diagnostic categories. The key finding is impaired LES relaxation as indicated by raised “integrated relaxation pressure (IRP > 15 mm Hg). Type I “classic” achalasia, often with luminal dilatation and little pressure activity in the esophageal body, Type II displays “pan-esophageal pressurization” on swallowing, and Type III “vigorous” achalasia is accompanied by spasm.
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