Achalasia It took forceful maneuvering of the endoscope to overcome the sphincter. Pathophysiologic studies of achalasia have primarily identified neural lesion involving loss of ganglion cell within the myenteric plexus, degeneration of the vagus nerve, and changes in the dorsal motor nucleus of the vagus. These changes result in aperistalsis in the esophageal body, impairment of lower esophageal sphincter relaxation
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