Achalasia

Achalasia is a relatively rare disorder of the smooth muscle of the esophagus. The esophagus is a muscular tube that carries food and liquids from the mouth to ...

condition

Definition

Achalasia is a relatively rare disorder of the smooth muscle of the esophagus. The esophagus is a muscular tube that carries food and liquids from the mouth to the stomach. Achalasia makes it difficult for food and liquid to pass into the stomach from the esophagus.

Causes

There is a muscle called the lower esophageal sphincter (LES) where the esophagus meets the stomach. When not swallowing, the LES remains closed to keep food, liquid, and stomach acid from moving back into the esophageal tube. When swallowing, nerve signals tell muscles to contract to push food down the esophagus (an action called peristalsis) and allow the LES to open.

In people with achalasia, the nerve cells in the lower esophageal tube and the LES do not work correctly. This results in:

Absent peristaltic (muscular) activity
Failure of the LES to open completely

While achalasia is associated with the loss of nerve cells in the esophagus, the cause of this process is unknown.

Risk

A risk factor is something that increases your chance of getting a disease or condition. Because the exact cause of achalasia is unknown, risk factors are unknown.

Symptoms

Symptoms of achalasia can occur between the ages of 25 and 60. Symptoms rarely develop in children. Symptoms tend to be mild at first, and then grow worse over months or years. The main symptom is difficulty swallowing solids and, as the disorder progresses, liquids. As many as 70% to 97% of patients with achalasia have difficulty swallowing both solids and liquids.

Other symptoms may include:

Discomfort or pain in the chest (under the breastbone, especially after meals)
Coughing, especially when lying down
Heartburn
Weight loss (as the disorder progresses)
Vomiting or regurgitating food or liquids—In some people, this occurs during sleep. This can result in inhalation of food particles or liquid, which can lead to aspiration pneumonia and other respiratory infections.

Heartburn / Reflux Disease

diagnosis

Diagnosis

Patients with achalasia usually compensate for their dysphagia by taking smaller bites, chewing well, and eating slowly leading to a delay in making the diagnosis for months or even years. Several tests may be ordered to help make the diagnosis.

Barium Swallow

A barium swallow is often the first test ordered. During this diagnostic test, you'll drink a chalky liquid containing barium that coats your upper digestive tract. This provides a clear silhouette of your esophagus, stomach and the upper part of your small intestine (duodenum) on an X-ray. A barium X-ray reveals how well the liquid passes into the stomach and how well the esophagus functions. It may show that the lower esophageal sphincter does not relax.

Endoscopy

In this test, you are sedated and your doctor passes a thin, flexible tube equipped with a fiber-optic light and video camera system (endoscope) down your throat and into your esophagus and stomach. It may be normal in early achalasia but is important because it excludes the presence of esophageal cancer.

Esophageal manometry

Manometry measures the pressure generated by the contracting esophageal muscle. It is performed by passing a thin tube through the nose, down the back of the throat and into the esophagus. In a patient with achalasia, no peristaltic waves are seen in the lower half of the esophagus after swallows, and the pressure within the contracted lower esophageal sphincter does not fall with the swallow.

treatment

Treatment

Treatments for achalasia include dilation or stretching of the lower esophageal sphincter (dilation), the injection of botulinum toxin (Botox) into the sphincter and surgery to cut the lower esophageal sphincter (esophagomyotomy).

All of these treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach. However, surgery provides the best chance for long term improvement.

prevention

Prevention

There are no guidelines for the prevention of achalasia because the cause is usually not known.

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