ACHALASIA OF THE OESOPHAGUS
This 67 year old female who suffered from generalized atherosclerosis and hypertension, was admitted with a story of gradual mental deterioration accompanied by incontinence. There was steady deterioration in the ward and death. At necropsy there was cerebral infarction. The specimen demonstrated was obtained at necropsy.
The specimen is the oesophagus (27 cm), cardia, and a portion of stomach wall (10 x 10 cm). The organs have been laid open to display the mucosal surfaces. The oesophagus is narrowed at the cardia to approximately 2cm in circumference. Above this constriction is dilated (maximum 10 cm). In the dilated portion the mucosa is reddened and the muscule coat of the lower three-fourths is markedly hypertrophied. There is patchy mucosal ulceration 7cm from the cardia. The gastric mucosa appears relatively normal apart from some patchy reddening. The rugal pattern is less obvious than usual. (The small longitudinal tear at the lower end of the oesophagus is an artefact). The diagnosis is of achalasia of the oesophagus.
This condition was formerly attributed to muscle spasm at the lower end of the oesophagus ("cardiospasm"). It is now believed to result from a primary disturbance of oesophageal mobility.