Achalasia: A mechanical and sensitivity disorder
Abstract
Dear editor, We read the original article written by Karyampudi et al. with great interest. The authors used a very robust methodology, reporting a high rate of severe esophagitis after per-oral endoscopic myotomy, although the patients seem to be oligosymptomatic of gastroesophageal reflux. Instead, they resemble the condition “silent gastroesophageal reflux disease,” in which patients suffer from severe reflux with few or no symptoms. The authors have hypothesized that mucosal denervation during submucosal tunneling and myotomy may result in esophageal hyposensitivity. However, esophageal hyposensibility may be due to the achalasia itself. Chemical, physical, and thermal stimulus may induce the nociceptors of the esophagus. The nociceptive receptors on the esophageal nerves transmit to the central nervous system via either the spinal or vagal nerves. Mechanical stimuli can cause heartburn and include esophageal distention and longitudinal contraction of esophageal smooth muscle. In achalasia patients, this mechanism is probably ineffective in inducing heartburn. The esophagus diameter is naturally enlarged and the refluxate probably does not cause a distention stimulus in the esophagus. Also, the longitudinal contraction does not happen due to the denervation of esophageal smooth muscle. In fact, some studies have shown achalasia patients have a lower mechanosensitivity to esophageal distention. In addition, the same nervous degeneration that may be part of the underlying…
Read the paper
Related studies
- Advantages and Disadvantages of Long-term Proton Pump Inhibitor Use
- Ivth brazilian consensus conference on helicobacter pylori infection
- A pSMAD/CDX2 complex is essential for the intestinalization of epithelial metaplasia
- S2k-Leitlinie Gastroösophageale Refluxkrankheit und eosinophile Ösophagitis der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – März 2023 – AWMF-Registernummer: 021–013
- Step-by-step management of refractory gastresophageal reflux disease
- Insights into Effects/Risks of Chronic Hypergastrinemia and Lifelong PPI Treatment in Man Based on Studies of Patients with Zollinger–Ellison Syndrome
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.