Pathogenesis of achalasia cardia

作     者：Uday C Ghoshal Sunil B Daschakraborty Renu Singh 

作者机构：Department of GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknow 226104India 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2012年第18卷第24期

页      面：3050-3057页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Esophagus Motor dysphagia Motility disor-der Peristalsis Esophageal sphincter 

摘      要：Achalasia cardia is one of the common causes of motor *** the disease was first described more than 300 years ago,exact pathogenesis of this condition still remains ***,achalasia cardia is caused by loss of inhibitory ganglion in the myenteric plexus of the *** the initial stage,degeneration of inhibitory nerves in the esophagus results in unopposed action of excitatory neurotransmitters such as acetylcholine,resulting in high amplitude non-peristaltic contractions(vigorous achalasia);progressive loss of cholinergic neurons over time results in dilation and low amplitude simultaneous contractions in the esophageal body(classic achalasia).Since the initial description,several studies have attempted to explore initiating agents that may cause the disease,such as viral infection,other environmental factors,autoimmunity,and genetic *** Chagas disease,which mimics achalasia,is caused by an infective agent,available evidence suggests that infection may not be an independent cause of primary achalasia.A genetic basis for achalasia is supported by reports showing occurrence of disease in monozygotic twins,siblings and other first-degree relatives and occurrence in association with other genetic diseases such as Down s syndrome and Parkinson s *** in genes encoding for nitric oxide synthase,receptors for vasoactive intestinal peptide,interleukin 23 and the ALADIN gene have been ***,studies on larger numbers of patients and controls from different ethnic groups are needed before definite conclusions can be ***,the disease is believed to be multi-factorial,with autoimmune mechanisms triggered by infection in a genetically predisposed individual leading to degeneration of inhibitory ganglia in the wall of the esophagus.