Achalasia

Achalasia is a benign pathology of the esophagus.

General

• Uncommon.
• Risk factor for squamous cell carcinoma (in men and women) and adenocarcinoma (in men).
• Due to loss of ganglion cells.

Clinical:

• Dysphagia (difficulty swallowing) liquids and solids.

DDx:

• Chagas disease - classically with dilation of the esophagus.

Treatment:

• Endoscopic dilation.
• Peroral endoscopic myotomy (POEM).
• Laparoscopic myotomy.

Microscopic

Features:

• Mucosa typically normal - even in long-standing achalasia.

Note:

• Achalasia seen in the context of a resection usually has inflammation.
• Post-Heller myotomy often has inflammation.

Sign out

ESOPHAGUS, BIOPSY:
- SQUAMOUS EPITHELIUM WITH A MILD DEEP LYMPHOCYTIC INFILTRATE, EDEMA, AND
  REACTIVE CHANGES, NO EOSINOPHILS APPARENT.
- SCANT COLUMNAR EPITHELIUM WITH MINIMAL STROMA, NO APPARENT SIGNIFICANT PATHOLOGY.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

Alternate

GASTROESOPHAGEAL JUNCTION, BIOPSY:
- COLUMNAR EPITHELIUM WITH MODERATE CHRONIC INFLAMMATION.
- REACTIVE SQUAMOUS EPITHELIUM.
- NEGATIVE FOR INTESTINAL METAPLASIA.
- NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY.

See also

• Esophagus.
• Esophageal stricture.
• POEM.