Pathophysiology and treatment of achalasia in a muscle mechanical perspective

Annals of the New York Academy of Sciences
Hans Gregersen, Kar Man Lo

Abstract

This review provides a biomechanical perspective on the pathophysiology and treatment of achalasia. The esophagus is efficient in transporting ingested material to the stomach in healthy subjects. A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago-gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy. Clinical features and current literature are interpreted using well-known muscle mechanics models and terms from cardiac mechanophysiology. The preload, afterload, length-tension, and strain softening concepts in particular are useful for understanding the remodeling induced by achalasia. The concepts are also useful in understanding the treatment that aim to reduce the lower esophageal sphincter pressure that does not relax sufficiently in achalasia. These treatments cover endoscopic or laparoscopic myotomy, pneumatic balloon dilation, and Botox injections. In addition to the intended reduction of the afterload for aboral transport of ingested materials, the treatments tend to induce gastroesophageal reflu...Continue Reading

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Citations

Apr 3, 2020·Journal of Neurogastroenterology and Motility·Hye-Kyung JungUNKNOWN Korean Society of Neurogastroenterology and Motility

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