MEDizzy - A 49-year-old woman presents with increasing problems

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Gastrointestinal System

A 49-year-old woman presents with increasing problems swallowing food (progressive dysphagia). X-ray studies with contrast reveal that she has a markedly dilated esophagus above the level of the lower esophageal sphincter (LES). No lesions are seen within the lumen of the esophagus. Which of the following is the most likely cause of this disorder?

ExplanationAchalasia, which means “unrelaxation,” is a term that describes the absence of normal lower esophageal sphincter (LES) relaxation. This condition results from decreased or absent ganglion cells in the myenteric plexus in the body of the esophagus. The etiology of this neuronal loss is unknown in many cases; however, some cases are secondary to other diseases, such as diabetes mellitus, amyloidosis, sarcoidosis, and Chagas disease, which is caused by Trypanosoma cruzi. Because of the increased LES pressure and the absence of peristaltic waves in the lower esophagus, the esophagus in these patients is dilated and tortuous above the level of the LES. Barium x-ray studies reveal this dilation. The distal esophagus has a characteristic “beaklike” appearance. Patients with achalasia have an increased risk of developing aspiration pneumonia and squamous cell carcinoma.