Achalasia of the Esophagus: A Surgical Disease

Achalasia is a primary esophageal motility disorder of unclear etiology. As treatment has evolved during the past 10 to 15 years, it has become primarily a surgical disease. It is uncommon, but: not rare, affecting approximately I in 100,000 individuals per year.(1) Occurring equally in men and women, it is an acquired condition usually diagnosed between 20 and 50 years of age, but can occur at any age. In 1672, Sir Thomas William first described the disease as cardiospasm and treated the problem with dilation using a whale sponge attached to a whale bone. It Was not until 1927, when A F Hurst determined that the problem was the result of all inability of the lower esophageal sphincter (LES) to relax, and named the disease achalasia, a Greek term meaning failure to relax.(2) Normal Individuals have a lower esophageal high-pressure zone, which completely relaxes with initiation of a swallow. In achalasia, residual pressures in the LES remain well above normal after swallowing, resulting in a functional Outflow obstruction at the gastroesophageal junction. In addition, the LES call be hypertensive, resulting ill higher than normal resting pressures, and the esophageal body is aperistaltic, all leading to failure of bolus transport.(3) When untreated, intraesophageal pressures rise and the esophagus slowly dilates, often to the point of gross deformity.(4)