Before learning the types of achalasia, what is achalasia?
Achalasia is a rare motility disorder affecting the ability of the lower esophageal sphincter to relax. Its name is derived from the Greek word Achalesein, meaning "fail to relax".
The lower esophageal sphincter closes off the esophagus from the stomach and in people with the condition, the sphincter is not opened when swallowing - this impaired relaxation leads to the incomplete emptying of food from the esophagus into the stomach, causing a back-up of food within the esophagus. It affects around 0.5 in every 1,000,000 people per year.
Types of achalasia: Diagnosis is usually attained using high-resolution manometry, a diagnostic system using a series of pressure sensors within the gastrointestinal tract to measure motility based on the intraluminal pressure recorded.
There are three different classifications (Chigaco classification) of the diagnosis; type I, type II and type III. Each type has characteristics unique to the classification and is ascertained during diagnosis when using HRM (high-resolution manometry).
Type I shows a minimal esophageal pressurization during the test, type II displays pan-esophageal pressurization and type III is characterized by rapid propagated esophageal pressurization which can be attributed to spastic contractions.
Prognosis can differ depending on which classification of the condition a person is diagnosed with, as treatment success can vary with each individual case. After diagnosis and bariatric swallow to ascertain the scope of the condition and axis of the esophagus, several treatments may be needed before long-term success is identified.
Once diagnosed, the first line of treatment is to dilate or alter the sphincter in order to achieve the desired motility. Pneumatic dilation is a common treatment and is usually considered first. The treatment involves inserting a surgical balloon into your esophagus and inflating it once it's in. This helps to stretch out the sphincter to allow your esophagus to function at a better level.
There are also surgical options when combating achalasia. Esophagomyotomy is a surgical procedure where a small incision is made to gain access to the sphincter. It is then carefully altered by the surgeon to allow for improved motility and a better flow into the stomach.
Most of these surgeries are deemed a success, but some patients report symptoms of gastroesophageal reflux disease shortly after, mainly heartburn.
For those who are not able to undergo either of these treatments or if the treatments have not been successful, a Botox injection may be offered to forcibly relax the sphincter muscles.
During this procedure, Botox is injected directly into the sphincter using an endoscope.
In the event of these treatments not working adequately or as a long-term solution, nitrates and calcium channel blockers may help to relax the sphincter to allow food to pass through more easily.
Each of the different classifications of achalasia indicates the severity of the condition as the classification ascends, so type III is the most severe classification of the condition. However, this doesn't mean that Type I is the easiest to treat and type III is the most difficult.
In fact, Type II Achalasia is actually the classification which shows the most treatment success in response to either pneumatic dilatation (PD) or laparoscopic Heller myotomy (LHM) than those who display type I or type III.
Achalasia is most commonly seen in adults who are middle-aged or older, although the condition can be present in children as well.
There is also a correlation between those with autoimmune diseases and those with Achalasia, meaning a person is more likely to have achalasia if they also have an autoimmune disorder.
The symptoms of achalasia include weight loss due to food not being able to pass into the stomach, regurgitation of food (backflow), heartburn, chest pain during or after eating, cough and difficulty swallowing. Depending on the severity of the condition within an individual, the presence of achalasia may not be obvious.
The condition is caused by damage to the nerves of the esophagus or damage to the sphincter and there are no current prevention guidelines as the condition cannot be prevented (as far as we know), therefore it is important to see a doctor if you believe you have any of the symptoms of achalasia before the effects become worse.