Overview of achalasia
Achalasia is a rare disorder that makes it difficult for food and liquid to pass from the esophagus, which connects the mouth and stomach.
Achalasia occurs when the nerves in the esophagus are damaged. As a result, the esophagus freezes and breaks down over time, eventually losing the ability to digest food. The food then collects in the esophagus, sometimes fermenting, and rinsing back in the mouth, causing a bitter taste. Some people mistake this for gastroesophageal reflux disease (GERD). However, in achalasia, the food comes from the esophagus, while in GERD the substance comes from the stomach.
There is no cure for achalasia. After the esophagus is frozen, the muscles do not work properly again. But symptoms can usually be controlled with endoscopy, minimally invasive therapy, or surgery.
What are the symptoms of achalasia?
People with achalasia often have trouble swallowing or feel like food is stuck in their esophagus. This is also known as dysphagia. This symptom causes coughing and increases the risk of aspiration, inhalation, or choking on food. Other features:
- Chest pain or discomfort
- Weight Loss
- Severe pain or discomfort after eating
You may also have regurgitation or reflux. However, these can be symptoms of other gastrointestinal conditions like acid reflux.
Who is affected by achalasia?
Achalasia thrives on approximately 3,000 people in the United States each year. It is usually diagnosed in adults, but it also occurs in children. There is no specific race or ethnic group affected, and this condition does not run in families.
Is achalasia serious?
Slowly, over many years, people with achalasia have a harder time eating solid foods and drinking liquids. As your condition progresses, this can lead to significant weight loss and malnutrition. People with this disease also have a slightly higher risk of esophageal cancer, especially if there are long-term complications.
What causes achalasia?
This can occur for a variety of reasons. It is difficult for your doctor to find a specific cause. This condition can be hereditary or it can be the result of an autoimmune condition. With this type of condition, your body’s immune system will accidentally attack healthy cells in your body. Degeneration of the nerves of the esophagus often contributes to the advanced symptoms.
Other conditions can cause symptoms similar to those of achalasia. Cancer of the esophagus is one of these conditions. Another cause is a rare parasitic infection called Chagas disease. The disease occurs mainly in South America.
How is achalasia diagnosed?
Your doctor might suspect you have achalasia if you have trouble swallowing both solids and liquids, particularly if it gets worse over time.
Your doctor may use esophageal manometry. This involves placing a tube in your esophagus while you swallow. The tube records the muscle activity and makes sure your esophagus is functioning properly.
An X-ray or similar exam of your esophagus may also be helpful in diagnosing this condition. Other doctors prefer to perform an endoscopy. In this procedure, your doctor will insert a tube with a small camera on the end into your esophagus to look for problems.
Another diagnostic method is a barium swallow. If you have this test, you’ll swallow barium prepared in liquid form. Your doctor will then track the barium’s movement down your esophagus through X-rays.
Treatment for achalasia
Several types of treatment can either temporarily reduce your symptoms or permanently alter the function of the valve.
As first-line therapy, your doctors can either dilate the sphincter or alter it. Pneumatic dilation typically involves inserting a balloon into your esophagus and inflating it. This stretches out the sphincter and helps your esophagus function better. However, sometimes dilation tears the sphincter. If this happens, you may need additional surgery to repair it.
Esophagomyotomy is a type of surgery that can help you if you have achalasia. Your doctor will use a large or small incision to access the sphincter and carefully alter it to allow better flow into the stomach. The great majority of esophagostomy procedures are successful. However, some people have problems afterward with gastroesophageal reflux disease (GERD). If you have GERD, your stomach acid backs up into your esophagus. This can cause heartburn.