Which condition is characterized by complete loss of esophageal peristalsis with a nonrelaxing LES?

Which condition is characterized by complete loss of esophageal peristalsis with a nonrelaxing LES?

• A. GERD
• B. Achalasia
• C. Esophageal Cancer
• D. Spastic Esophagus

Answer: (B)

Esophageal motility disorder where the esophageal body has no organized peristaltic waves and the lower esophageal sphincter fails to relax. This combination defines a classic achalasia pattern: aperistalsis of the esophagus with a nonrelaxing LES leads to failure of bolus transit into the stomach, producing dysphagia for both solids and liquids and often regurgitation of undigested food. The underlying issue is degeneration of the inhibitory nerves in the esophageal myenteric plexus, so the LES remains tight and the esophagus can’t generate coordinated contractions. In contrast, GERD involves reflux due to an often incompetent or transiently relaxing LES but with preserved or only partially impaired esophageal peristalsis, so the motility pattern isn’t the same. Esophageal cancer causes obstruction that typically starts with solids and progresses, with weight loss and risk factors rather than a global loss of peristalsis. Spastic esophagus features uncoordinated or overly strong contractions but LES relaxation is generally normal, so the key combination of absent peristalsis and a nonrelaxing LES points to achalasia.

Esophageal motility disorder where the esophageal body has no organized peristaltic waves and the lower esophageal sphincter fails to relax. This combination defines a classic achalasia pattern: aperistalsis of the esophagus with a nonrelaxing LES leads to failure of bolus transit into the stomach, producing dysphagia for both solids and liquids and often regurgitation of undigested food. The underlying issue is degeneration of the inhibitory nerves in the esophageal myenteric plexus, so the LES remains tight and the esophagus can’t generate coordinated contractions.

In contrast, GERD involves reflux due to an often incompetent or transiently relaxing LES but with preserved or only partially impaired esophageal peristalsis, so the motility pattern isn’t the same. Esophageal cancer causes obstruction that typically starts with solids and progresses, with weight loss and risk factors rather than a global loss of peristalsis. Spastic esophagus features uncoordinated or overly strong contractions but LES relaxation is generally normal, so the key combination of absent peristalsis and a nonrelaxing LES points to achalasia.