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Korean J Helicobacter  Up Gastrointest Res > Volume 14(2); 2014 > Article
The Korean Journal of Helicobacter  and Upper Gastrointestinal Research 2014;14(2):71-78.
DOI: https://doi.org/10.7704/kjhugr.2014.14.2.71    Published online June 10, 2014.
Pathogenesis of Achalasia
Moo In Park
Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea. mipark@ns.kosinmed.or.kr
식도이완불능증의 병태생리
박무인
고신대학교 의과대학 내과학교실
Abstract
Achalasia is a rare esophageal motilty disorder characterized by loss of myenteric neurons leading to aperistalsis of the esophageal body and impaired relaxation of the lower esophageal sphincter (LES). Esophageal peristalsis and relaxation of the LES are mediated by myenteric neurons. Achalasia may be an autoimmune disease targeting esophageal myenteric neurons with cell-mediated and antibody-mediated attack to an unidentified antigen. It is still unknown how these immunologic attacks begin and why these are functionally limited to the esophagus. Initial immunologic reactions can begin in genetically predisposed persons who had viral infection, such as herpes simplex virus 1. The type of immune response and the intensity of the cytotoxic T-cell attack can determine the clinical presentation of the disease. Patients with Chicago Classification type III achalasia may present with chronic inflammation in the absence of neuronal loss, where as patients with Chicago Classification type I or II achalasia present with a predominantly cytotoxic immune response with progressive loss of myenteric neurons. Further well controlled researches which reveal the unknown facts of pathogenesis are needed.
Key Words: Achalasia; Pathogenesis; Lower esophageal sphincter; Myenteric plexus; Inflammation


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