Overview
Achalasia is a condition that makes it difficult for the esophagus to properly move food from the mouth into the stomach. (The esophagus is the muscular tube that normally transports food from the mouth to the stomach, also called the “food pipe” on occasion.)
Commonly Associated With
Swallowing problems for liquids and solids, Cardiospasm, lower esophageal sphincter spasm, and Esophageal achalasia
Causes of Achalasia
At the point where the esophagus and stomach meet, there is a muscular ring called the lower esophageal sphincter (LES). This muscle normally relaxes upon the person swallowing so that food is allowed to pass into the stomach from the esophagus. In those with achalasia, however, the LES does not relax as it should. In addition to this problem, the esophagus is also lacking the normal amount of muscle activity (known as peristalsis). This lack can either be partial or total, and without it the esophagus does not move food down its length very well at all.
As a result of damage to the nerves of the esophagus, these issues emerge.
Other illnesses can cause similar symptoms to achalasia, including cancer of the upper stomach or esophagus, and a parasite infection the leads to Chagas disease.
Achalasia is a rare disorder. It has been known to occur at any age, but is most often seen in people ages 25-60. Achalasia can sometimes be genetic in nature, and can be passed down through families.
Symptoms of Achalasia
Symptoms can include:
Chest pain, which can manifest in the neck, back, or arms. The pain also tends to increase after eating.
Unintentional weight loss
Backflow (regurgitation) food or drink items
Heartburn
Cough
Difficulty swallowing solids and liquids
Exams And Tests For Achalasia
A physical exam by a health care provider can show signs of malnutrition or anemia. Consequently, they may order other tests.
Diagnostic tests can include:
- An EGD or upper endoscopy, which is a test that uses a flexible tube with a camera attached to it to examine the lining of the esophagus and stomach.
- A upper GI x-ray.
- Manometry, which is a test to determine if the esophagus is functioning properly.
Treatment Of Achalasia
The overall goal of the various treatments available is to reduce the pressure at the LES muscle, and as a result allow foods and liquids to pass more easily into the stomach from the esophagus.
Therapy can involve:
- Medications, such as long-acting calcium channel blockers or nitrates. These can relax the lower esophagus sphincter (LES). Unfortunately, this treatment is fairly short-term, as long-term solutions to achalasia are often uncommon.
- An injection with botulinum toxin (Botox) to help relax the LES muscles. However, benefits of this treatment tend to wear off within a few weeks or months.
- A widening (dilation) of the esophagus. Done during an EGD procedure, a balloon dilator stretches the LES.
- A specific surgery (called a myotomy) that cuts the LES in an attempt to relax the LES muscles more permanently.
Above all, a health care provider should help determine which treatment is best for the patient.
Outlook (Prognosis)
The outcomes of surgical and non-surgical treatments are oftentimes quite similar. Therefore, several treatments done in succession are occasionally necessary.
Possible Complications Of Achalasia
Complications can include:
- Perforation (tearing) of the esophagus is possible
- Aspiration (breathing food contents into the lungs, subsequently causing pneumonia) is possible
- Regurgitation (backflow) of acid or food from the stomach into the esophagus (known as acid reflux) is possible
When to Contact a Medical Professional
Contact a health care provider immediately if:
● Swallowing is difficult or painful
● Symptoms of achalasia continue, even with treatment
Prevention of Achalasia
Most causes of achalasia cannot be fully prevented. However, treatment can often help to prevent future complications.
