The Evolution of Achalasia

Excerpt

Esophageal motility abnormalities have been described as existing in a spectrum which includes achalasia, distal esophageal spasm, nutcracker esophagus and possibly other less distinct motility findings. There has been much questioning and controversy relevant to whether these different manometric features evolve from one to another and thus form a changing spectrum amongst themselves. Most clear in the reported literature extending back into the 1960s are reports of esophageal spasm “evolving” into more typical achalasia over time [1]. What has never been established, however, is whether a less clear form of motility defect can be identified that will predictably evolve into classic achalasia. It is intuitive, however, that the patient with a normal esophagus when exposed to the etiologic agent for achalasia (currently unknown) would show a progression (evolution?) of manometric changes over time. …