What is a typical histological finding in achalasia?

In achalasia, a typical histological finding is the absence of ganglia of Auerbach's plexus, which is a crucial part of the enteric nervous system located in the muscular layers of the esophagus. Auerbach's plexus, also known as the myenteric plexus, is responsible for coordinating peristalsis and promoting relaxation of the lower esophageal sphincter (LES). In achalasia, the degeneration or destruction of these ganglion cells leads to inadequate peristalsis in the esophagus and failure of the LES to relax properly during swallowing. This dysfunctional activity is why patients experience symptoms such as dysphagia, regurgitation, and sometimes chest pain.

The other choices do not align with the pathophysiology of achalasia. The presence of multiple ganglia is not observed; rather, there is a significant reduction or complete absence of these ganglia. An increase in goblet cells is typically associated with respiratory conditions or gastrointestinal responses but does not characterize achalasia. Lastly, while fibrosis of the esophageal wall may occur as a secondary change over time due to chronic inflammation or increased pressure, it is not a primary finding associated with this disorder. The absence of ganglia is