What is the clinical significance of regurgitation in achalasia?

• A. Regurgitation of undigested food due to failure of bolus transit across a non-relaxing LES.
• B. Regurgitation of acid due to LES hypertonicity.
• C. Regurgitation of bile due to duodenogastric reflux.
• D. Regurgitation of saliva without swallowing issues.

Answer: (A)

In achalasia, the lower esophageal sphincter fails to relax and peristalsis in the esophagus is lost, so swallowed food cannot pass into the stomach. That causes food to linger and then be pushed back up, leading to regurgitation of undigested material. The regurgitated contents are not acidic because they haven’t entered the stomach, which is why this regurgitation is of undigested food rather than acid reflux. Clinically, this regurgitation is important because it can occur at night and raise the risk of aspiration, choking, halitosis, and weight loss from poor intake. This pattern helps distinguish achalasia from conditions like gastroesophageal reflux disease, where regurgitation is typically acidic, or from bile reflux or saliva regurgitation, which have different mechanisms and presentations.