• Eyal Shteyer, Simon Edvardson, Sarah L Wynia-Smith, Ciro Leonardo Pierri, Tzili Zangen, Saar Hashavya, Michal Begin, Barak Yaacov, Yuval Cinamon, Benjamin Z Koplewitz, Amos Vromen, Orly Elpeleg, and Brian C Smith.
• Pediatric Gastroenterology Unit, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. Electronic address: eyals@szmc.org.il.
• Gastroenterology. 2015 Mar 1;148(3):533-536.e4.

AbstractNitric oxide is thought to have a role in the pathogenesis of achalasia. We performed a genetic analysis of 2 siblings with infant-onset achalasia. Exome analysis revealed that they were homozygous for a premature stop codon in the gene encoding nitric oxide synthase 1. Kinetic analyses and molecular modeling showed that the truncated protein product has defects in folding, nitric oxide production, and binding of cofactors. Heller myotomy had no effect in these patients, but sildenafil therapy increased their ability to drink. The finding recapitulates the previously reported phenotype of nitric oxide synthase 1-deficient mice, which have achalasia. Nitric oxide signaling appears to be involved in the pathogenesis of achalasia in humans.Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.

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