Achalasia following reflux disease: coincidence, consequence, or accommodation? An experience-based literature review

Achalasia is a motility disorder of the esophagus characterized by the defective peristaltic activity of the esophageal body and impaired relaxation of the lower esophageal sphincter due to the degeneration of the inhibitory neurons in the myenteric plexus of the esophageal wall. The histopathologic...

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Bibliographic Details
Published in:Therapeutics and clinical risk management 2018-01, Vol.14, p.39-45
Main Authors: Vereczkei, András, Bognár, Laura, Papp, András, Horváth, Örs Péter
Format: Article
Language:English
Subjects:
Achalasia
Acids
Barium
Barrett’s oesophagus
Case Series
Dysphagia
Endoscopy
Esophagus
Gastroesophageal reflux
gastroesophageal reflux disease
Hypertension
Laparoscopy
Literature reviews
Morphology
Neurons
Nissen fundoplication
Patients
Surgery
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Summary:Achalasia is a motility disorder of the esophagus characterized by the defective peristaltic activity of the esophageal body and impaired relaxation of the lower esophageal sphincter due to the degeneration of the inhibitory neurons in the myenteric plexus of the esophageal wall. The histopathological and pathophysiological changes in achalasia have been well described. However, the exact etiological factors leading to the disease still remain unclear. Currently, achalasia is believed to be a multifactorial disease, involving both extrinsic and intrinsic factors. Based on our experience and the review of literature, we believe that gastroesophageal reflux disease (GERD) might be one of the triggering factors leading to the development of achalasia. However, it is also stated that the two diseases can simultaneously appear independently from each other. Considering the large number and routine treatment of patients with GERD and achalasia, the rare combination of the two may even remain unnoticed; thus, the analysis of larger patient groups with this entity is not feasible. In this context, we report four cases where long-standing reflux symptoms preceded the development of achalasia. A literature review of the available data is also given. We hypothesize that achalasia following the chronic acid exposure of the esophagus is not accidental but either a consequence of a chronic inflammation or a protective reaction of the organism in order to prevent aspiration and lessen reflux-related symptoms. This hypothesis awaits further clinical confirmation.
ISSN:1176-6336
1178-203X
1178-203X
DOI:10.2147/TCRM.S152429