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A fine balance exists between the peristaltic forces generated in the esophageal body (which herein is defined as the preload) and the resistance in the outlet, the esophago\u2010gastric junction (which is defined as the afterload). Achalasia is a rare esophageal disease that progressively over many years challenges esophageal efficacy. Clinical features and current literature are interpreted using well\u2010known muscle mechanics models and terms from cardiac mechanophysiology. The preload, afterload, length\u2013tension, and strain softening concepts in particular are useful for understanding the remodeling induced by achalasia. The concepts are also useful in understanding the treatment that aim to reduce the lower esophageal sphincter pressure that does not relax sufficiently in achalasia. These treatments cover endoscopic or laparoscopic myotomy, pneumatic balloon dilation, and Botox injections. In addition to the intended reduction of the afterload for aboral transport of ingested materials, the treatments tend to induce gastroesophageal reflux in some patients because they obliterate an important component in the reflux barrier.<\/jats:p>","DOI":"10.1111\/nyas.13711","type":"journal-article","created":{"date-parts":[[2018,5,14]],"date-time":"2018-05-14T09:03:25Z","timestamp":1526288605000},"page":"173-184","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Pathophysiology and treatment of achalasia in a muscle mechanical perspective"],"prefix":"10.1111","volume":"1434","author":[{"given":"Hans","family":"Gregersen","sequence":"first","affiliation":[{"name":"GIOME, Department of Surgery the Chinese University of Hong Kong, Prince of Wales Hospital  Shatin Hong Kong"},{"name":"California Medical Innovations Institute  San Diego California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kar Man","family":"Lo","sequence":"additional","affiliation":[{"name":"GIOME DoubleCove  Wu Kai Sha New Territories Hong Kong"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,14]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/nyas.13109"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-010-1546-1"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000092877"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2005.067769"},{"key":"e_1_2_11_6_1","first-page":"G221","article-title":"Origin of sensation in the esophagus","volume":"246","author":"Christensen J.","year":"1984","journal-title":"Am. 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