L’acalasia (dal greco mancato rilasciamento), da non confondere con la calasia, è la più comune patologia motoria primitiva dell’esofago. La malattia è caratterizzata dalla perdita progressiva della peristalsi esofagea e dalla incapacità di rilasciamento dello Sfintere esofageo inferiore (LES), posto al confine tra esofago e stomaco. Il ruolo fisiologico del LES è quello di impedire il reflusso del contenuto gastrico nell’esofago. Normalmente, durante la deglutizione, lo sfintere si rilascia, consentendo la progressione del bolo alimentare nello stomaco. In caso di acalasia, il LES resta sempre tonico e il rilasciamento è incompleto, per cui si verifica ristagno di materiale alimentare nel lume esofageo. Tale ristagno provoca una progressiva dilatazione dell’esofago, tanto che la malattia è anche denominata megaesofago.
L’acalasia ha una prevalenza di 1/10.000, senza differenze tra i due sessi e con la massima frequenza tra i 30 e i 50 anni.
È dovuta a un’anomala innervazione della muscolatura liscia dell’esofago. Tre sono i possibili meccanismi:
patologia infettiva neurotropa (come malattia di Chagas l’agente è noto essere il Tripanosoma cruzii)
degenerazione dei plessi intramurali (plesso di Auerbach)
disordine infiammatorio autoimmune.
Ci sono inoltre forme di disautonomia familiare in cui si hanno anche alterazioni del sistema nervoso autonomo.
È riportata l’associazione di acalasia con insufficienza surenalica e assenza di lacrimazione (sindrome di Allgrave).
Sintomi
Il sintomo cardinale della acalasia è la disfagia (sensazione di arresto del bolo alimentare nell’esofago). La disfagia si manifesta sia per i liquidi che per i solidi, ma inizialmente può essere paradossa, perché il paziente deglutisce bene i solidi, ma non i liquidi, in quanto i solidi grazie al loro maggior peso possono progredire più facilmente lungo l’esofago, anche in assenza di peristalsi.
Gli altri sintomi comprendono: rigurgito di cibo indigerito nel 70% dei casi, soprattutto notturno, favorito dal decubito; tosse notturna, causata dal rigurgito che può penetrare nelle vie respiratorie; polmonite ab ingestis, una complicazione del precedente sintomo; scialorrea (eccessiva salivazione); alitosi, poiché il cibo che ristagna nell’esofago fermenta e dà alitosi; dolore toracico e pirosi possono essere presenti nel 30% dei casi, quale conseguenza di aumentata pressione esofagea o esofagite da stasi. Un altro sintomo è la perdita di peso.
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