I've been teaching medical education for over 10 years, and there have been numerous subjects,

numerous schools, numerous countries that I've taught material.

And the one thing that stays constant is that there are certain things that we as people in health care

understand and there are certain things that stay behind a mental block.

For example, during the basic science years we always have trouble with biochemistry and the reason why is that while you're in the class you understand it's probably important for a lot of reasons

but no patient has ever walked in and said my hexokinase feels a little bit low.

Similarly, conditions like Van Heppolindau or things like achelasia are conditions that we

seem to understand briefly for the exams during basic science, but the true understanding of it seems

to escape us.

And so that's why this week we're going to be doing our next topic in the Dysphasia series.

I'm Dr. Niket's son-Paul Paul your friendly neighborhood internist and

gastrointestinal entrantrologists welcome to this week's podcast where we're going to be

discussing accolia. So before we kick off what what exactly is acylasia?

Well, acylasia is when the lower esophageal sphincture

fails to relax. And the reason for this is a progressive degeneration

of the ganglionic cells in the myantere plexus at the end of the esophagus.

In other words, the end of the esophagus is too tight.

Now it's actually pretty uncommon.

You only see about a case every 100,000 people, but some studies suggest

that the numbers are rising, so there must be a variable somewhere we're unaware of.

It's equal in men and women. It can occur at any age, and the thing to remember is that the type of

acalasia that results from Japanosomi cruzy, that protozone parasite we see in Central

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