c S
 is defined as a sensation of "sticking" or obstruction of the passage of food through

the mouth, pharynx, or esophagus

c {
 signifies complete esophageal obstruction, which is usually due to bolus impaction and
represents a medical emergency. 
    

     occurs in disorders of the
voluntary phase of swallowing. However, once initiated, swallowing is completed normally.
 
 means painful swallowing
c Sysphagia caused by a large bolus or a narrow lumen is called mechanical dysphagia, whereas
dysphagia due to weakness of peristaltic contractions or to impaired deglutitive inhibition causing
nonperistaltic contractions and impaired sphincter relaxation is called motor dysphagia.
c 
S  In an adult, the esophageal lumen can distend up to 4 cm in diameter.
When the esophagus cannot dilate beyond 2.5 cm in diameter, dysphagia to normal solid food can
occur. Sysphagia is always present when the esophagus cannot distend beyond 1.3 cm.
Circumferential lesions produce dysphagia more consistently than do lesions that involve only a
portion of circumferences of the esophageal wall, as uninvolved segments retain their
distensibility.
c Common causes include carcinoma, peptic and other benign strictures, and lower esophageal ring.
Esophageal motor dysphagia may result from abnormalities in peristalsis and deglutitive inhibition
due to diseases of the esophageal striated or smooth muscle.
c  
 is a motor disorder of the esophageal smooth muscle and involves thoracic and
abdominal parts of the esophagus. In achalasia, the esophageal body loses peristaltic contractions
and the LES does not relax normally in response to swallowing.
c J
HOJHYSIOLOGY:
he underlying abnormality is the loss of intramural neurons. Inhibitory
neurons containing VIJ and nitric oxide synthase are predominantly involved, but cholinergic
neurons are also affected in advanced disease. Jrimary idiopathic achalasia accounts for most of
the cases seen in the United States. Secondary achalasia may be caused by gastric carcinoma that
infiltrates the esophagus, lymphoma, Chagas' disease, certain viral infections, eosinophilic
gastroenteritis, and neurodegenerative disorders.
c