Achalasia is a swallowing disorder caused by a loss of function in the esophageal body and the lower esophageal sphincter (the muscular ring at the junction of the oesophagus and the stomach). Normally, when people swallow, the esophageal body will sequentially contact the sphincter, which relaxes to allow food and liquid to pass into the stomach. With achalasia, the esophageal body does not contact and the sphincter does not relax, which causes food to be lodged in that area.
Cause of Achalasia
Many medical experts believe that the degeneration of the nerve cells that signal the brain to relax the esophageal body and the esophageal sphincter causes achalasia. Although the underlying cause of this degeneration is unknown, some have proposed an autoimmune disease or infectious source.
Symptoms of Achalasia
Symptoms usually worsen over time, leading to the person not tolerating both solid and liquid diets. These symptoms include:
- Difficulty swallowing and “getting stuck”
- Regurgitation of food
- Heartburn
- Belching
- Nighttime cough
- Vomiting
Diagnosis of Achalasia
Usually suspected based upon the presence of the symptoms described above, specific tests are needed to confirm the diagnosis and rule out other conditions with similar symptoms, such as the following investigations:
- Endoscopy
- Barium swallow x-ray
- Esophageal Manometry
- Computerised Tomography Scan (CT Scan)
- 24 hrs. pH-Impedance Monitoring
Treatment for Achalasia
The aim of treatment is to allow food to pass through more easily, using medication, balloon dilation, surgery, or endoscopic treatment (Botulinum toxin injection). Occasionally, medications such as calcium channel blockers or nitrate-based compounds will help relieve symptoms of achalasia, but these treatments are generally ineffective in most patients.
Balloon Pneumatic dilation involves the insertion of an inflatable balloon down the oesophagus to the sphincter, where it is inflated to force the sphincter open. This is effective in about 70-80% of patients, but multiple sessions are often required, and there is the risk of esophageal perforation.
The surgery to relieve achalasia is called an esophageal myotomy, after which about 80-85% of patients experience long-term relief. This involves dividing the muscularis of the upper stomach and the lower oesophagus.
Nutrition plays an important role prior to, and in conjunction with, these procedures. A dietitian will most likely recommend foods or liquids that are calorie dense and easily swallowed.
Achalasia is an uncommon disorder of the oesophagus that your physician may treat with any treatment options which previously mentioned base on the individual patient.
How to Prevent Achalasia?
Since the cause of achalasia is not known, the condition is not preventable. Early treatment, however, can lessen the chance of complications.
Complications of Achalasia
- Aspiration of food contents into the lung can cause pneumonia
- Malnutrition
- Risk of esophageal cancer
