Systemic pathology: achalasia: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Systemic pathology: achalasia

Sample item

A 35-year-old man has progressive dysphagia for both solids and liquids with regurgitation of undigested food. Barium swallow shows a dilated oesophagus tapering to a bird-beak, and manometry shows failure of lower oesophageal sphincter relaxation. Which histological finding is expected in primary disease?

ATransmural granulomatous inflammation with fissuresBIntraepithelial eosinophilsCColumnar metaplasia with goblet cellsDLoss of ganglion cells in the myenteric plexus

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Loss of ganglion cells in the myenteric plexus

Primary achalasia results from degeneration of inhibitory ganglion neurons in the myenteric (Auerbach) plexus, so the lower oesophageal sphincter cannot relax and peristalsis is lost. In Chagas disease the same loss occurs from Trypanosoma cruzi. The disease increases the risk of squamous cell carcinoma.

Option by option

A. Transmural granulomatous inflammation with fissures
Transmural granulomas suggest Crohn disease and are not a feature of achalasia.
B. Intraepithelial eosinophils
Intraepithelial eosinophils indicate eosinophilic oesophagitis.
C. Columnar metaplasia with goblet cells
Columnar metaplasia with goblet cells is Barrett oesophagus following reflux.
D. Loss of ganglion cells in the myenteric plexus (correct)
Correct. Loss of myenteric ganglion cells removes inhibitory relaxation of the sphincter.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Loss of ganglion cells in the myenteric plexus. Primary achalasia results from degeneration of inhibitory ganglion neurons in the myenteric (Auerbach) plexus, so the lower oesophageal sphincter cannot relax and peristalsis is lost.

Why is "Transmural granulomatous inflammation with fissures" not the answer?

Transmural granulomas suggest Crohn disease and are not a feature of achalasia.

Why is "Intraepithelial eosinophils" not the answer?

Intraepithelial eosinophils indicate eosinophilic oesophagitis.

Why is "Columnar metaplasia with goblet cells" not the answer?

Columnar metaplasia with goblet cells is Barrett oesophagus following reflux.

What concept does this question test?

It tests Systemic pathology: achalasia in Pathology. In Chagas disease the same loss occurs from Trypanosoma cruzi. The disease increases the risk of squamous cell carcinoma.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Systemic pathology: achalasia?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.