Achalasia is an esophageal disorder in which the lower esophageal sphincter does not relax completely. It is one of the most studied esophageal motility disorder. In addition to that the wavelike muscle movement to push the food downwards, also known as peristalsis does not occur in the esophagus. And that results in the food not being able to get from the mouth to the stomach.
What Are The Causes of Achalasia?
Achalasia is relatively rare and is caused by the inflammation and degeneration of neurons of the esophageal wall. But what causes this inflammation and degeneration is unclear.
It is hypothesized to be an immune response to a previously exposed virus, genetic predisposition.
Secondary achalasia is seen in people with Chaga’s disease caused by Trypanosoma cruzi, a species of parasitic euglenoids. Other reasons include esophageal infiltration by gastric carcinoma, a paraneoplastic syndrome which means is that a tumor such as lung cancer can secrete antibodies and mimic the pattern of achalasia (1).
What Are The Symptoms?
Symptoms of achalasia include dysphagia which means having difficulty in swallowing. Patients mostly have difficulty in swallowing liquids and solids. It is often progressive. It is really disturbing as food gets stuck in the upper throat or mid-chest. This is the main symptom and the other symptoms are a result of indigestion of food.
Regurgitation of food ingested several hours or a day earlier occurs in patients.
Weight loss occurs in patients because of indigestion of food and because nutrients do not get absorbed by the body.
Chest pain, fullness are other symptoms of achalasia.
There can be an aspiration or choking sensation, especially when food comes up at night and can enter the lungs
Atypical heartburn experienced by patients with achalasia is not due to acid reflux but is due to fermentation of food in the esophagus. However, these symptoms are also seen in patients with acid reflux.
How to Diagnose Achalasia?
To diagnose achalasia your doctor can use different tests like
- Upper Endoscopy: In an upper endoscopy, a camera is inserted into the mouth to thoroughly examine the esophagus, stomach, and small intestine. This test is used to examine the causes of difficulty in swallowing.
- Esophagram: In this test, a patient has to swallow some dye which then helps the radiologist to take pictures of the inside organs and the pattern is then investigated for disorders of the esophagus.
- Esophageal Manometry: It is a procedure to measure the pressure developed and the muscle coordination in the esophagus during swallow of food. The patterns are very specific to the diagnosis of achalasia.
There is no single test that can be used alone to find if a patient has achalasia. To assure if a patient has achalasia he or she needs to go through a variety of tests.
To exclude other disorders like tumors, patients are also asked to go through CT scans. Tumors in older patients or in patients who smoke can mimic achalasia.
Different Types of Achalasia
Based on the manometric pattern, achalasia is categorized into three types. And it is important to know the type of achalasia as the treatment option varies (2).
- Type I Achalasia or Classic Achalasia
- Type II Achalasia
- Type III Achalasia or Spastic Achalasia
Different Treatment Options
Achalasia cannot be completely cured but the condition can definitely be improved.
- Oral medications: Medicines like calcium-chain blockers class and nitrates are used to relax the esophageal sphincter but are less effective and they come with intolerable side effects. Your doctor can ask you to use them occasionally.
- Botulinum Toxin: Botulinum toxin injections have been effective in some patients. It is a protein that paralyzes the muscle. It is injected in the lower esophageal sphincter. it is used in patients who are too ill to undergo other treatment options. However, the injection loses efficacy after using it repeatedly. And so the effect is temporary.
- Pneumatic dilation: This treatment option has been for quite a few years. It uses a balloon dilator and weakens the lower esophageal sphincter by stretching it.
- Heller Myotomy: It is a surgical procedure in which surgeons cut the esophagus to allow the food to pass to the stomach. It is effective but leads to acid reflux and so myotomy is usually followed by an antireflux procedure.
- Esophagectomy: It is a major surgical procedure done in patients who have failed other treatment options like myotomy.
Patients with achalasia are often put on a liquid diet. It is always recommended to visit your doctor on a regular basis.