Achalasia is a serious disorder of the esophagus that prevents normal swallowing. The esophagus is the tube which carries food from the throat to the stomach. Achalasia occurs when nerves in the tube connecting your mouth and stomach are damaged. As a result, people with achalasia have difficulty swallowing food. There is no cure for achalasia. But symptoms can usually be managed with minimally invasive therapy or surgery.
Achalasia is an uncommon disorder with an annual incidence of approximately 1.6 cases per 100,000 individuals and the prevalence of 10 cases per 100,000 individuals. Men and women are affected equally.
Achalasia is caused by degeneration of the nerve cells that give a sign to the brain to relax the esophageal sphincter. However, the exact cause of achalasia is not yet known. This condition may be hereditary or may be the result of an autoimmune disease or hidden infection. There are some other conditions that can cause symptoms similar to achalasia. Cancer of the esophagus is one of these conditions.
Another cause is a rare parasitic infection called Chagas’ disease, which occurs mostly in South America. Achalasia usually occurs later in life, but it can also occur in children. Individuals who are middle-aged and older are at higher risk of getting achalasia.
The most common symptom of achalasia is dysphagia or difficulty swallowing. People with achalasia usually have trouble swallowing both liquid and solid foods, often feeling that food “gets stuck” on the way down. Symptoms will get gradually worse. Other possible symptoms include:
- Difficulty swallowing food
- Pain or discomfort in the chest from esophageal dilation
- Weight loss
- Intense pain or discomfort after eating
- Regurgitation or backflow of food
Diagnosis of achalasia begins with complete medical history. To test for achalasia, the doctor is likely to recommend:
- Esophageal manometry
In this test, a thin tube is placed into the esophagus to measure the muscle activity and how well the lower esophageal sphincter relaxes or opens during a swallow, as well as make sure the esophagus is functioning properly.
- X-rays of the esophagus
An X-ray or similar exam of your esophagus may also be helpful in diagnosing this condition. It is taken after patients drink a chalky liquid that coats and fills the inside lining of the digestive tract. The coating allows doctors to see a silhouette of the esophagus, stomach, and upper intestine. Patients may also be asked to swallow a barium pill to act as a contrast agent and reveal the outlines of the esophagus in greater detail.
It can be used to define a partial blockage of the esophagus if a patient’s symptoms indicate the possibility. In this test, the doctor will pass a tube containing a lens and a light source into the esophagus, which can look directly at the surface of the esophagus. This test can also detect tumors that cause symptoms similar to achalasia. Cancer of the esophagus occurs as a complication of achalasia in 2-7% of patients.
treatment depends on a patient’s age and the severity of the condition.
Treatment options for achalasia include non-surgical and surgical ones.
- Pneumatic dilation
In this procedure, an inflatable membrane or balloon is inserted into the esophageal sphincter and inflated to force the sphincter open. This procedure may need to be repeated normally within six years if the esophageal sphincter doesn’t stay open. It is effective in about 70% of patients.
- Botox (botulinum toxin type A)
It is a muscle relaxant that can be injected directly into the esophageal sphincter with an endoscope to paralyze the muscle and allow it to relax. Symptoms usually return within one to two years, so the injections may need to be repeated, and repeat injections will make it more difficult to perform surgery later if needed.
Doctors might suggest muscle relaxants such as nitroglycerin or nifedipine before eating. Taken daily, these drugs provide relief for about two-thirds of patients for as long as two years. These medications will limit treatment effect and severe side effects. Medications are generally recommended only if pneumatic dilation or Botox do not help.
Surgery may be recommended for younger people because nonsurgical treatment is less effective in this group. In addition, sometimes dilation therapy tears the sphincter. If this happens, additional surgery is also necessary.
For example, Esophagomyotomy is a type of surgery that can help you if you have achalasia. Another surgical option can be taken is Heller myotomy. People who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). If you have GERD, your stomach acid backs up into your esophagus. This can cause heartburn.
Before taking any treatment options, it is necessary to consult with your doctor.