There is a weakness in the lower part of the esophagus (smooth muscle), and the lower esophageal sphincter does not open and let food pass through.
Symptoms usually appear when the patient is a young adult, but may also occur at any age.
Experts do not know what causes achalasia. There is incomplete lower esophageal sphincter relaxation and increased tone. The smooth muscle inside the esophagus cannot move food down properly - known as aperistalsis of the esophagus.
Typically, the patient may experience only minor problems and ignores them. Eventually, however, swallowing of food and liquid becomes harder to do.
The esophagus, also known as the gullet or swallowing tube is the tube that connects the throat (pharynx) with the stomach, it is located between the windpipe (trachea) and the spine. It goes down the neck and joins the upper (cardiac) end of the stomach. An adult esophagus is approximately 10 inches (25 centimeters) long. When we swallow, the muscles within the esophagus walls contract and push the food or liquid down into the stomach. Glands within the esophagus produce mucus, which facilitates swallowing.
What are the signs and symptoms of achalasia?
- Dysphagia - difficulty in swallowing
- Regurgitation of indigested food
- As symptoms worsen regurgitation involves liquids as well as foods
- Some may experience weight loss
- Coughing, especially when lying down
- Chest pain, often perceived as heartburn. In some cases the patient may think he/she is having a heart attack
- Aspiration - food, liquid and saliva which is retained in the esophagus can be inhaled into the lungs
Diagnosing achalasiaAchalasia symptoms are similar to those of GERD (gastroesophageal reflux disease), hiatus hernia and some psychosomatic disorders; the condition is often mistaken for something else.
The doctor may order the following diagnostic tests:
- Barium swallow - the patient swallows a white liquid solution, known as barium sulfate. Barium sulfate is visible to x-rays. As the patient swallows the suspension, the esophagus becomes coated with a thin layer of barium, enabling the hollow structure to be imaged.
- Esophageal manometry - carried out to measure muscle pressure and movements in the esophagus. A pressuring device called a monometer is used. The doctor may do it to rule out cancer. A thin tube goes through the patient's nose and he/she is asked to swallow several times. The device measures muscle contractions in various parts of the esophagus. This procedure helps the doctor determine whether the lower esophageal sphincter is relaxing properly while the patient swallows. It can also tell how well the smooth muscle is working.
- Biopsy - not commonly used when diagnosing achalasia. A sample is removed during endoscopy.
What are the treatment options for achalasia?Drugs - If diagnosis is done early on, medications can help dilate the narrowed part of the esophagus so that food can pass through properly. Examples include calcium channel blockers and nitrates. Some patients may experience headaches and swollen feet. After some months some medications stop working.
Balloon (pneumatic) dilation - A small balloon in the narrowed section may be inflated, widening it.
Myotomy - An operation to cut the muscle usually helps prevent obstruction. It has a success rate of between 85% to 95%.
Botox - given as injections can be administered to relax muscles on the lower part of the esophagus. However, after three months the procedure will have to be done again. Botox injections may be required for those who are unable or unfit to undergo surgery.
Lifestyle changes - before and after treatment patients will have to eat slowly, chew their food more thoroughly, and drink lots of water during their meals. Meals should not be consumed near bedtime. If the individual sleeps with the head slightly raised, gravity can help empty the esophagus so that food does not regurgitate or stay stuck. After surgery or some procedures, proton pump inhibitors may help prevent gastric acid secretion, thus preventing reflux. Some foods that encourage reflux will have to be avoided, such as citrus fruits, alcohol, caffeine, chocolate and ketchup.
Acupuncture - some patients report improved symptoms after treatment with acupuncture.