They coined the term achalasia, meaning failure to relax. Achalasia is a primary esophageal motility disorder characterized by failure of a hypertensive LES to relax and absence of esophageal peristalsis. These abnormalities cause a functional obstruction at the gastroesophageal junction. Persons with achalasia lack nonadrenergic, noncholinergic inhibitory ganglion cells, causing an imbalance in excitatory and inhibitory neurotransmission. The result is a hypertensive, nonrelaxed esophageal sphincter.
Physical examination is noncontributory.
Lab studies are noncontributory. Barium swallow The esophagus appears dilated, and contrast material passes slowly into the stomach as the LES opens intermittently. If a tumor is suspected, perform an endoscopic ultrasound at the same time. Calcium channel blockers and nitrates are used to decrease LES pressure. This treatment is used primarily in elderly patients who have contraindications to either pneumatic dilatation or surgery.