Achalasia is a rare motility disorder with incomplete relaxation of the lower esophageal sphincter and ineffective contractions of the esophageal body. It has been hypothesized that achalasia does not result from only one pathway but rather involves a combination of infectious, autoimmune, and familial etiological components. On the basis of other observations, a novel hypothesis suggests that a muscular form of eosinophilic esophagitis is involved in the pathophysiology of achalasia in some patients. This appears to progressively diminish the myenteric plexus at stage III, gradually destroy it at stage II, and finally eliminate it at stage I, the most advanced and final stage of achalasia. Although high‐resolution manometry has identified these three different types of achalasia, another subset of patients with a normal‐appearing sphincter relaxation has been proposed. Provocative maneuvers, such as the rapid drinking challenge, have recently been demonstrated to improve diagnosis in certain borderline patients, but have to be studied in more detail. However, whether the different types of achalasia will have a long‐term impact on tailored therapies is still a matter of debate. Additionally, novel aspects of the standard timed barium swallow appear to be an important adjunct of diagnosis, as it has been shown to have a diagnostic as well as a predictive value.

中文翻译：

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贲门失弛缓症：生理学和诊断

贲门失弛缓症是一种罕见的运动障碍，下食管括约肌松弛不完全，食管体收缩无效。已经假设贲门失弛缓症不仅仅由一种途径引起，而是涉及传染性、自身免疫性和家族性病因成分的组合。根据其他观察结果，一个新的假设表明嗜酸性粒细胞性食管炎的肌肉形式参与了一些患者贲门失弛缓症的病理生理学。这似乎在 III 期逐渐减少肌间神经丛，在 II 期逐渐破坏它，最后在 I 期（贲门失弛缓症的最晚期和最后阶段）消除。尽管高分辨率测压法已经确定了这三种不同类型的贲门失弛缓症，已经提出了另一组具有正常外观的括约肌松弛的患者。最近已经证明刺激性操作，例如快速饮酒挑战，可以改善某些边缘患者的诊断，但必须进行更详细的研究。然而，不同类型的贲门失弛缓症是否会对定制疗法产生长期影响仍然是一个有争议的问题。此外，标准定时钡剂吞咽的新方面似乎是诊断的重要辅助手段，因为它已被证明具有诊断和预测价值。不同类型的贲门失弛缓症是否会对定制疗法产生长期影响仍然是一个有争议的问题。此外，标准定时钡剂吞咽的新方面似乎是诊断的重要辅助手段，因为它已被证明具有诊断和预测价值。不同类型的贲门失弛缓症是否会对定制疗法产生长期影响仍然是一个有争议的问题。此外，标准定时钡剂吞咽的新方面似乎是诊断的重要辅助手段，因为它已被证明具有诊断和预测价值。