Achalasia
Description
- Primary oesophageal motility disorder: loss of inhibitory (nitrergic, VIP) neurons in the myenteric (Auerbach) plexus
- -> absent oesophageal peristalsis + failure of LOS relaxation
- Excitatory cholinergic neurons are spared -> unopposed contraction -> inc resting LOS tone
Chicago classification subtypes (high-resolution manometry) - they predict treatment response
| Type | Pattern | Response |
|---|---|---|
| I | Aperistalsis, no pressurisation | Good |
| II | Panoesophageal pressurisation | Best response to any therapy |
| III | Spastic - premature/spastic distal contractions | Worst; POEM preferred (longer myotomy) |
- Type III behaves more like a spastic disorder than classic achalasia
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