Achalasia

Written by Seth Stoltzfus and Elizabeth Boskey, PhD | Published on July 16, 2012
Medically Reviewed by George Krucik, MD

Overview

Achalasia is a condition that affects the esophagus, the tube that carries food from the throat to the stomach. In individuals with achalasia, the esophagus does not work properly. Food may become trapped in it. This condition can be related to damage to nerves in the esophagus. It can also be caused by damage to the lower esophageal sphincter. The lower esophageal sphincter is a valve that closes off the esophagus from the stomach.

What Causes Achalasia?

Achalasia can happen for different reasons. It can be difficult for doctors to point out specific causes. This condition may be hereditary, or it may be caused by an autoimmune condition, where the body attacks itself. Degeneration of nerves in the esophagus often contributes to the advanced symptoms of the condition.

Other conditions can cause symptoms similar to achalasia. Cancer of the esophagus is one of these conditions. Another is a rare parasitic infection called Chagas disease.

Who Is at Risk for Achalasia?

Achalasia usually occurs later in life. Individuals middle-aged and older are at higher risk for the condition. Achalasia is also more common in people with a family history of the condition and people with autoimmune disorders.

What Are the Symptoms of Achalasia?

People with achalasia will often have trouble swallowing, or feel like food is stuck in the esophagus. This is also known as dysphasia. This symptom can cause coughing and raises the risk of aspiration, i.e. inhaling or choking on food. Other symptoms include:

  • pain or discomfort in the chest
  • weight loss
  • heartburn
  • intense pain or discomfort after eating

People with achalasia can also experience regurgitation or backflow. However, these can be symptoms of other gastrological conditions such as acid reflux.

How Is Achalasia Diagnosed?

Doctors often suspect achalasia in patients who have trouble swallowing both solids and liquids, particularly when this problem gets worse over time.

To diagnose achalasia, doctors may use esophageal manometry. This involves having a tube placed in your esophagus while you swallow. The tube records the muscle activity and makes certain everything is working correctly. An X-ray, or similar exam, of your esophagus may also be used to diagnose this condition. Other doctors prefer to perform an endoscopy. In this procedure, a small camera is put into the esophagus to look for problems.

How Is Achalasia Treated?

Most achalasia treatments involve the lower esophageal sphincter. Several types of treatment can be used to either temporarily reduce your symptoms or permanently alter the function of the valve.

The first line of treatment is often oral medications. Nitrates or calcium channel blockers can help to relax the sphincter so food can pass through it more easily. Doctors might also use Botox to relax the sphincter.

To treat achalasia more permanently, doctors can either dilate the sphincter or alter it. Dilation is typically done by inserting a balloon into the esophagus and inflating it. This stretches out the sphincter and helps your esophagus function better. However, sometimes dilation tears the sphincter. If this happens, you may need additional surgery to repair it.

Esophagomyotomy is a type of surgery used to help people with achalasia. Doctors use a large or small incision to access the sphincter and carefully alter it to allow better flow into the stomach. The great majority of esophagomyotomy procedures are successful. However, some patients have problems afterward with gastroesophageal reflux disease (GERD), where stomach acid backs up into the esophagus. This can cause heartburn.

What Can Be Expected in the Long Term?

Prognosis for this condition varies. Some people only have very mild symptoms. For others, treatment can be highly successful. Sometimes multiple treatments are needed to handle symptoms.

Unfortunately, if a dilation procedure doesn’t work the first time, surgery may be needed. Usually, the chance of success decreases with each successive dilation. Therefore, doctors will often seek alternatives if several dilations are not successful.

The success rate for esophagomyotomy is thought to be 80-90%. However, patients may develop some complications. These include:

  • issues related to tearing of the esophagus
  • acid reflux
  • respiratory conditions caused by food travelling up the esophagus and into the windpipe
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