Esophageal achalasia. It is a low frequency pathology that affects esophageal motility due to myenteric denervation of the esophagus and also, in a large proportion of cases, of the stomach . Its causes remain still poorly clarified and their diagnosis is still delayed, reporting a lag of at the least 5 years from the onset of symptoms, often confused with diseases such as disease by gastroesophageal reflux disease , among others. For this reason, it requires a high index of suspicion and a complete study, esophageal manometry being the gold standard.
Achalasia was the first disorder of esophageal motility to be clinically recognized, and can be defined as a disease of unknown etiology, characterized by the absence of peristalsis of the esophageal body and the inability of the lower esophageal sphincter (LES) to relax in response to the swallowing (the term achalasia etymologically expresses “failure of the sphincterto relax”). Both motor alterations determine an esophageal dilation (megaesophagus) with alimentary stasis, responsible for most of the symptoms and complications of this disease. In the present manuscript, a review of esophageal achalasia will be carried out from a clinical point of view, emphasizing those eminently practical aspects. Thus, the review will focus primarily on clinical manifestations, diagnostic methods, and therapeutic alternatives.
Treatment is currently not curative, and is focused on symptom relief. The surgical alternatives available are: Heller’s Myotomy , endoscopic dilation, and the most recent peroral endoscopic myotomy (POEM). Medical treatment has not shown good results and today it has restricted indications.