Achalasia

Achalasia is a rare disorder of the esophagus that makes swallowing difficult, leading to regurgitation of food and potentially serious complications if left untreated.

What is Achalasia?

Achalasia is a motility disorder of the esophagus, characterized by the inability of the lower esophageal sphincter (LES) to relax, allowing food to pass into the stomach. The LES is a ring-like muscle that separates the esophagus and stomach, and normally relaxes to allow food to enter the stomach. In achalasia, the LES remains constricted, causing a buildup of food in the esophagus.

Symptoms of Achalasia

The symptoms of achalasia may develop gradually over time and can vary in severity. Common symptoms include:

• Dysphagia (difficulty swallowing) to both liquids and solids
• Regurgitation of food, which may be effortless and occur shortly after eating
• Chest pain or discomfort, which can be severe and may worsen over time
• Weight loss, as a result of difficulty eating and absorbing nutrients
• Coughing or choking, especially at night, due to aspiration of food into the lungs
• Difficulty burping or vomiting

Causes and Risk Factors of Achalasia

The exact cause of achalasia is not fully understood, but it is thought to be related to:

• Degeneration of the esophageal muscles and nerves
• Abnormal function of the LES
• Inflammation or scarring of the esophagus
• Genetic predisposition, as some families may be more prone to developing achalasia
• Certain medical conditions, such as Parkinson's disease, scleroderma, or Chagas disease

Treatments for Achalasia

Treatment for achalasia aims to relieve symptoms and improve swallowing. The following treatments may be used:

• Pneumatic dilation: a procedure in which a balloon is inserted through the mouth and into the esophagus, where it is inflated to stretch the LES and improve swallowing.
• Heller myotomy: a surgical procedure in which the muscles of the LES are cut to allow food to pass more easily into the stomach.
• Peroral endoscopic myotomy (POEM): a minimally invasive procedure in which a flexible tube with a camera and instruments is inserted through the mouth to cut the muscles of the LES.
• Botox injections: injections of botulinum toxin into the LES to relax the muscle and improve swallowing.
• Medications: such as nitrates or calcium channel blockers, which can help relax the LES and improve swallowing.
• Dietary changes: eating smaller, more frequent meals, avoiding spicy or fatty foods, and drinking plenty of water to help with swallowing.

Complications of Achalasia

If left untreated, achalasia can lead to serious complications, including:

• Malnutrition and weight loss
• Aspiration pneumonia, which can be life-threatening
• Esophageal cancer, as the chronic inflammation and scarring of the esophagus may increase the risk of developing cancer.

Diagnosis of Achalasia

Achalasia is typically diagnosed using a combination of the following tests:

• Barium swallow: an X-ray test that uses barium to visualize the esophagus and stomach.
• Endoscopy: a procedure in which a flexible tube with a camera is inserted through the mouth to visualize the inside of the esophagus and stomach.
• Manometry: a test that measures the muscle contractions of the esophagus and LES.
• Esophageal pH monitoring: a test that measures the acidity of the esophagus to rule out gastroesophageal reflux disease (GERD).