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Achalasia

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 the stomach. Achalasia makes it difficult for food and liquid to pass into the stomach from the esophagus.

Causes of Achalasia

The esophagus meets the stomach in a muscle called the lower esophageal sphincter (LES). 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). This allows 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:

  • Missing 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.

Symptoms of Achalasia

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 70-97 percent of patients with achalasia have difficulty swallowing both solids and liquids.

Other symptoms may include:

  • Discomfort or pain in the chest, especially after meals
  • Coughing, especially when lying down
  • Heartburn
  • Weight loss (as the disorder progresses)
  • Vomiting or regurgitating food or liquids. This may occur during sleep. This can cause a person to inhale food particles or liquid, which can lead to aspiration pneumonia and other respiratory infections.

Heartburn / Reflux Disease

Gastroesophageal Reflux

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Diagnosing Achalasia

Patients with achalasia usually take smaller bites, chew well and eat slowly, which can lead to a delay in making a diagnosis. Several tests may be ordered to help make the diagnosis.

Barium Swallow

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 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

Your doctor passes a thin, flexible tube with a fiber-optic light and video camera system (endoscope) down your throat and into your esophagus and stomach. It helps rule out the presence of esophageal cancer.

Esophageal manometry

Manometry measures the pressure generated by the contracting esophageal muscle. Your doctor passes a thin tube through your nose, down the back of the throat and into your 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 for Achalasia

Treatments for achalasia include:

  • Dilation or stretching of the lower esophageal sphincter (dilation)
  • Botulinum toxin (Botox) injections into the sphincter
  • Surgery to cut the lower esophageal sphincter (esophagomyotomy)

These treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach. Surgery provides the best chance for long-term improvement.

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Content was created using EBSCO’s Health Library. Edits to original content made by Rector and Visitors of the University of Virginia. This information is not a substitute for professional medical advice.

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