ACHALASIA
Achalasia is a rare disorder of the esophagus that is marked by an impaired ability to push food and liquid into the stomach.
- The esophagus is a tube that carries food from the throat to the stomach.
- Achalasia is a disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter.
- The lower esophageal sphincter is a muscular ring located at the low end of the esophagus, where it meets the stomach.
- The lower esophageal sphincter opens up to allow food to pass through into the stomach. It also closes off to prevent acid and stomach contents from traveling backward from the stomach.
- In achalasia, the lower esophageal sphincter doesn’t fully relax and fails to open up during swallowing, making it difficult to push food down into the stomach.
- In addition to the abnormalities of the lower esophageal sphincter, the smooth muscle of the esophagus does not contract normally and cannot support peristaltic waves
- This process causes food to get caught at the base of the esophagus.
- The condition affects about 1 in 100,000 per year and occurs on both male and female.
CAUSES
The exact cause of the condition is unknown. Theories suggest that genetics an autoimmune disorder (that causes the body itself to damage the esophagus) may be responsible for achalasia.
In rare cases, achalasia may occur secondary to other conditions such as esophageal cancer and Chagas disease (a rare parasitic infection that is mostly seen in South America).
SYMPTOMS
- Trouble swallowing food. This can cause coughing and a risk of inhaling or choking on food.
- Regurgitation of undigested food retained in the esophagus
- Weight loss
- Chest pain usually of unclear cause
DIAGNOSIS AND TREATMENT
Achalasia may be diagnosed if there is trouble swallowing both liquids and solids, particularly if it gets worse over time.
To test for achalasia, the doctor may recommend:
- Esophageal manometry. This involves placing a tube in your esophagus while you swallow. The tube measures the rhythmic muscle contraction in your esophagus, the coordination, and force exerted by the esophageal muscle, and how well the lower esophageal sphincter relaxes or open during swallowing.
- Upper endoscopy to examine the inside of your stomach and esophagus.
- X-rays of your upper digestive system
TREATMENT
Treatment options aim at relaxing or opening the lower esophageal sphincter to allow food and liquid to move more easily through your digestive system.
Treatment options may be surgical or non-surgical.
Non-surgical treatment options may include:
- Stretching the esophagus (pneumatic dilation). A balloon is inserted in the esophageal sphincter and inflated to stretch the tight muscles. This procedure may be carried out several times before it helps.
- Medications such as muscle relaxants
- Botox injection. The doctor injects botulinum toxin type A directly into the esophageal sphincter to help relax the muscle temporarily to aid swallowing.
Surgical options may include:
- Heller myotomy, a procedure in which the muscle at the lower end of the esophageal sphincter is cut to allow food to move more easily to the stomach.
- Peroral endoscopic myotomy (POEM), where an endoscope is inserted into the mouth and down the throat to create a cut inside the lining of the esophagus. The doctor tunnels through this cut to reach the inner muscle at the lower end of the esophageal sphincter, where another cut is made. This helps in making swallowing easier.