Idiopathic loss of inhibitory neuron input to lower esophageal sphincter, leading to impaired relaxation of smooth muscle and impaired ability of food to leave esophagus and enter stomach
Risk Factors
Ages 30-60
M = F
Symptoms
Very slowly progressive dysphagia (months to years), w/subtle onset
Dysphagia is to solids and liquids
Usually do not have GERD sx; though can have a chest pain/pressure/squeezing sensation
Food sticks lower area esophagus; regurgitation
Pooling of saliva on pillow in AM
Nocturnal coughing
Sometimes hx recurrent aspiration pneumonia
Often mild weight loss
Tests
Characteristic "bird beak" appearance on barium swallow
Manometry demonstrating impaired LES relaxation
EGD often done as well to exclude any occult mass/pseudo achalasia