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Medicina Legal de Costa Rica

On-line version ISSN 2215-5287Print version ISSN 1409-0015


FERRANDINO CARBALLO, Fiorella  and  UMANA BRENES, Alberto Alonso. Acalasia como trastorno de la motilidad esofágica. Med. leg. Costa Rica [online]. 2016, vol.33, n.1, pp.269-274. ISSN 2215-5287.

Achalasia is an esophageal, primary motor disorder of unknown etiology, which was discovered by Sir Thomas Williams in 1674. It occurs equally in men and women, with the usual age of onset between 25 and 60 years. Pathophysiologically, there are an inflammatory process leading to a loss of inhibitory neurotransmitters and an imbalance between inhibitory and excitatory neurons. This triggers an increased cholinergic activity, which causes incomplete relaxation of the lower esophageal sphincter (LES). Clinically, the patient presents dysphagia, regurgitation, heartburn, dyspnea, chest pain and dysphonia. High resolution manometry constitutes together with the anamnesis, the gold standard for diagnosis. Manometry is characterized by insufficient LES relaxation and loss of esophageal peristalsis. Aperistalsis, esophageal dilation with minimal LES opening, “bird-peak” appearance, and poor emptying of barium are radiographically documented. Dilated esophagus with retention of saliva, liquid and undigested food particles in the absence of stenosis or mucosal tumors, are the main findings of the endoscopy. Treatment includes options such as drugs, botulinum toxin injection, pneumatic dilatation, myotomy, and esophagectomy.

Keywords : Esophagus; esophageal achalasia; deglutition disorders; lower esophageal sphincter; esophageal motility disorders, esophageal manometry.

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