Pathology
Lack of inhibitory ganglion cells result in imbalance of inhibitory and excitatory neurotransmitters (1,2).
- Excitatory release acetylcholine
- Inhibitory release vasoactive intestinal peptide (VIP) and nitric oxide (NO)
Macroscopically:
- dilatation of the oesophagus with thickening of the wall can lead to irreversible aperistalsis and worsening obstructive symptoms (1)
- secondary changes such as diverticulae and mucosal ulceration may occur
Microscopically:
- reduction or absence of ganglion cells in the myenteric plexus (1,2)
- changes secondary to denervation and stasis:
- hypertrophy of the oesophageal smooth muscle
- inflammatory changes in myenteric nerves (1)
Reference:
- (1) Momodu II, Wallen JM. Achalasia. [Updated 2021 Aug 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519515/ - article-17083.s4 (accessed 21 January 2022)
- (2) Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020 Sep;115(9):1393-1411. doi: 10.14309/ajg.0000000000000731. PMID: 32773454.
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