Idiopathic esophageal achalasia: a study of etiology and profile of the patients

Abstract

BACKGROUND: The idiopathic esophageal achalasia is a disease of unknown etiology, characterized by esophageal aperistalsis and failure of its lower sphincter with dysphagia. Its etiology factors includes: esophageal gastric junction obstruction, degeneration of Auerbach´s plexus, virus infection, congenital origin, autoimmune affection and injury by toxic agent. The achalasia diagnosis is reached after excluding Chagas disease possibilities, which includes seronegative results for Trypanosoma cruzi, absence of megacolon and epidemiology for Chagas disease. AIM: To characterize the disease and propose hypothesis concerning its etiology and associated factors. METHODS: Review of medical records from 78 patients operated at the Hospital de Clinicas da Unicamp obstruction between 1989 and 2005 and the subsequent interview, using directed questionnaire, reaching for common data between them and emphasizing history, possible co-morbidities and associated factors. In the group of 78 records collected it was possible to contact and interview 33 patients. RESULTS: The main findings of this study were: 1) presence of a triggering relevant emotional factor before the symptoms (80%) and over 30% with psychiatric and/or psychological treatment reported; 2) typical childhood infections highly prevalent (88% measles, varicella, rubella); 3) possible associations with: exposure to chemicals, especially herbicides; other diseases of the gastrointestinal tract, autoimmune diseases, genetic propensity and other changes in the nervous system highlighting the seizures. CONCLUSIONS: The idiopathic esophageal achalasia is probably an autoimmune disease, which seems to be highly related to emotional problems.