Achalasia: un trastorno de la motilidad esofágica, no tan raro

Abstract

Achalasia: a not so rare esophageal motility disorder Achalasia is a rare motility disorder of the distal esophagus, of unknown etiology. The irreversible destruction of esophageal myenteric plexus neurons causes aperistalsis and the failure of lower eso- phageal sphincter to relax during deglutition. Consequently, the food bolus stops at the level of the cardia producing disphagia and other symptoms such as regurgitation, chest pain, heartburn and weight loss. With a thorough medical history, upper GI endoscopy and barium swallow X-ray a diag- nosis of achalasia can be suspected and later confi rmed by esophageal manometry. Other diseases, especially malignant diseases, can imitate the clinical symptoms. Pneumatic balloon dilatation is the fi rst choice treatment for achalasia, but Heller myotomy is now becoming the treatment of choice in many hospitals because it is signifi cantly less invasive and costly. Heller myotomy together with laparoscopic fundoplication in order to prevent refl ux should be offered when dilatation therapy fails, especially in younger patients. I present two cases of achalasia, demonstrating that, although the incidence is approximately 1 per 100,000 people per year, it is not so infrequent in clinical practice as one would think.