PubMed · 14093307
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H CARLIOZ. 1963. [CARDIOSPASM].. https://pubmed.ncbi.nlm.nih.gov/14093307/
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Radiologic studies can be helpful when evaluating patients who are suspected of having esophageal motility disorders. Performing studies of the highest technical quality yields the most definitive results. The esophagus should be assessed for anatomic and functional abnormalities that may account for presenting symptoms. Motility disorders such as achalasia and scleroderma have specific radiographic findings that are described in this article; however, some motility disorders of the esophagus have nonspecific radiographic findings. In those cases, it is imperative that clinical and manometric information be combined with radiographic findings to provide accurate diagnoses. The radiographic examinations that are most commonly used include barium esophagography and nuclear medicine examinations. This article emphasizes the use of barium examinations to assess esophageal motility.
Idiopathic achalasia is an inflammatory disease of unknown etiology characterized by esophageal aperistalsis and failure of LES relaxation due to loss of inhibitory nitrinergic neurons in the esophageal myenteric plexus. Proposed causes of achalasia include gastroesophageal junction obstruction, neuronal degeneration, viral infection, genetic inheritance, and autoimmune disease. Current evidence suggests that the initial insult to the esophagus, perhaps a viral infection or some other environmental factor, results in myenteric plexus inflammation. The inflammation then leads to an autoimmune response in a susceptible population who may be genetically predisposed. Subsequently, chronic inflammation leads to destruction of the inhibitory myenteric ganglion cells resulting in the clinical syndrome of idiopathic achalasia. Further studies are needed to better understand the etiology and pathogenesis of achalasia-such an understanding will be important in developing safe, effective, and possibly curative therapy for achalasia.