Achalasia

What is Achalasia?

Achalasia or esophageal aperistalsis, megaesophagus, or cardiospasm is characterized by a marked decrease in esophageal contractions. It typically occurs between the ages of 20 and 60, and it gradually worsens when untreated.

It results in an increase in the latent pressure of the lower esophageal sphincter. The area above the lower sphincter can become enlarged and thus accumulate undigested food. It affects the ability to properly swallow liquids and solids, and it can cause a myriad of uncomfortable and troubling symptoms. It cannot be fully corrected, but it can be treated for symptom relief.

What are the Symptoms of Achalasia?

Symptoms of achalasia include problems swallowing liquids and solids.

Those with achalasia might also suffer from chest pain while swallowing or for no obvious reason, bouts of coughing while lying down and regurgitation of trapped food from the enlarged area of the esophagus. Regurgitation happens in approximately 33% of suffers while asleep. As a result, lung infections and other serious lung problems and/or significant weight loss can occur.

Achalasia Causes

Although the reasons for the disorder are not well documented or established, most of the causes researched point to three main factors.

Infections can cause the degeneration of the nerves in the esophagus, resulting in poor muscle response. Once the infection sets in, it causes inflammation in the lower esophagus area mainly around the nerve area. With time, the infection spreads and leads to degeneration of the nerves resulting in the LES, losing its ability to support peristaltic movements.

Heredity, in which the condition gets passed from one generation to another, is also a factor. Just like people get conditions such as diabetes despite living a healthy lifestyle, achalasia can happen purely through heredity and does not depend on how one lives.

Finally, abnormality in the immune system can lead to the body fighting against itself, resulting in damage to the esophagus. Auto immune conditions result in the body mistakenly attacking its healthy cells resulting in the degeneration of the cells. It’s this degeneration that leads to the advancement of the condition.

How is Achalasia Treated?

Before treating achalasia, the presence of an esophageal tumor must be ruled out. It will typically appear at the gastroesophageal junction. To view the muscular esophageal contractions, X-rays are taken while swallowing barium. Pressure levels are also taken via a small tube fitted with a camera. A biopsy is collected and examined to rule out cancer.

Treatment to relieve symptoms may include:

  • Calcium channel blockers or nitrates to relax the sphincter
  • Mechanical dilation to widen the sphincter
  • Botulinum toxin injections instead of mechanical dilation for short-term relief
  • Surgical procedures to widen the sphincter (myotomy) and a fundoplication to prevent acid reflux

When achalasia is caused by a tumor near the esophageal junction, surgery must be performed. However, when symptoms are caused by a cancerous tumor, it is usually late-stage. Survival can be prolonged with chemoradiotherapy. Early cancer detection through periodic exams is advised since it can offer curative treatments.

Achalasia Prevention

According to research, most of the achalasia cases are unpreventable. However, what doctors do is treat the condition in its early stages before it progresses to more severe stages and to avoid the more serious complications.

If left untreated, the condition causes massive damage to its victims and could lead to malnutrition, weight loss, lung infections resulting from food aspiration, pneumonia, among many more complications. So, how is the condition treated?

Surgery

Involves the cutting open of the valve muscles between esophagus and stomach. Then the patient requires a week or two for adequate recovery.

Balloon dilation

A non-surgical method that involves the doctor inserting a special balloon then inflating it to widen the sphincter opening to let food through. Patients may require repeated ballooning sessions to achieve satisfactory long term results.

Medication

Exists for patients not up for surgery and is commonly known as Botox injections. The injection works to release a protein in the muscles that make them relax and inhibit the nerves from sending the signals to tell the muscles to contract.

Resources
Last Reviewed:
September 11, 2016
Last Updated:
October 30, 2017