What Is Achalasia?: Meaning, Causes, Risk, Symptoms & Treatment

What is Achalasia?

Achalasia occurs when the mechanisms responsible for transporting food to the stomach fail to operate effectively. After swallowing, two essential actions must occur for food and liquids to traverse from the mouth to the stomach. Initially, the esophagus, the conduit for food to the stomach, must propel the food forward by contracting and relaxing. Subsequently, upon reaching the stomach, a small muscular flap or valve situated at the esophageal base must open to facilitate food emptying into the stomach.

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In individuals with achalasia, both of these processes are impaired. The esophagus struggles to propel food downward, and the valve fails to fully open. Consequently, food becomes trapped at the esophageal base, akin to a blocked sink, and may regurgitate into the mouth.

Achalasia is a rare condition, affecting approximately 1 in 100,000 individuals. Its onset can be gradual, taking years to manifest fully, and some individuals may overlook symptoms for an extended period before seeking medical attention. While the condition cannot be cured, various treatments are available to manage its symptoms and improve quality of life.

Causes of Achalasia

The exact reason for achalasia remains uncertain according to experts. However, potential factors include:

Inheritance from parents (genetics)
Autoimmune disorders
Viral infections
Degeneration of nerve function

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Achalasia Risk Factors

Achalasia can affect individuals of all ethnicities and is equally prevalent among both genders. While it primarily occurs in individuals aged 30 to 60, it can occasionally manifest in children as well. Additionally, achalasia is occasionally observed in individuals with Down syndrome.

Achalasia Symptoms

The primary symptom of achalasia is dysphagia, manifesting as difficulty in swallowing liquids and solid foods.

Other symptoms associated with this condition may include:

1. Chest pain, particularly following meals
2. Regurgitation of food into the throat
3. Heartburn and excessive belching
4. Unintentional weight loss
5. Nocturnal coughing
6. Episodes of vomiting
7. Pneumonia resulting from aspiration of food into the lungs
Symptoms may worsen when eating close to bedtime, and certain foods such as meat and bread may exacerbate the condition.

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Diagnosing Achalasia

Due to the similarities in symptoms between achalasia and heartburn, your doctor might initially treat you for heartburn. If this treatment proves ineffective, they are likely to proceed with testing for achalasia.

One common diagnostic method involves using an endoscope to examine your throat. Equipped with a miniature camera attached to a long tube, the endoscope allows the doctor to visualize the interior of your esophagus.

The barium swallow test and manometry are both frequently employed screening tests for achalasia. During manometry, a thin tube is inserted through your throat to assess the strength of the esophageal muscles while you swallow water. Additionally, it evaluates the functionality of the stomach valve.

Treatment for Achalasia

Surgery

Surgery stands as the foremost effective treatment for achalasia, offering long-term relief from symptoms for most individuals.

The primary surgical procedure, known as a Heller myotomy, is commonly conducted using a scope equipped with a camera and light, alongside other surgical instruments. The surgeon makes several minuscule incisions into the abdomen and employs the surgical tools to access the targeted area. The objective of the procedure is to widen a portion of the lower esophagus, facilitating easier swallowing. This approach typically yields high success rates.

Another surgical alternative, termed peroral endoscopic myotomy (POEM), avoids external incisions. Instead, a doctor inserts an endoscope—a small tool featuring a camera—through the mouth and down the throat. Once the interior is visible, a small incision is made in the esophageal lining, followed by tunneling through to reach the inner muscle of the lower esophagus, where another incision is performed to enhance swallowing ease.

While both surgical options are generally successful, they may induce acid reflux in certain individuals.

Your physician will discuss the most suitable procedure for your condition.

Other Treatment Options

Surgery may not be necessary for managing achalasia, as alternative interventions are available, albeit with comparatively lower efficacy, potentially necessitating multiple procedures.

These options include:

1. Injections of muscle-relaxing medication: Botox (botulinum toxin) is injected into the constricted esophageal muscles, temporarily relaxing them to enable normal swallowing.

2. Esophageal stretching (pneumatic dilation): A balloon is inserted into the valve between the esophagus and stomach and inflated to stretch the tight muscles. This procedure may require repetition before yielding significant improvement.

3. Medication: Nitrates and calcium channel blockers are two drug classes that relax the lower esophageal sphincter, reducing achalasia symptoms.

A2ditionally, a type of drug can be injected into the esophagus to facilitate food passage, though its effects are temporary, lasting from six months to a year.

The most appropriate treatment varies based on individual factors, and your doctor can assist in determining the optimal approach.

Living with Achalasia

While there is no specific diet for achalasia, you may discover certain foods that pass through the esophagus more easily.

Increasing water intake during meals might aid in swallowing. Carbonated beverages like colas sometimes help, as the carbonation assists in pushing food through the esophagus.

In severe cases, a liquid diet may be advisable for a period. Always consult your doctor regarding nutritional needs if solid foods are not tolerated. Significant weight loss should be reported to your doctor, as it could indicate malnutrition.

Some individuals with achalasia face an increased risk of esophageal cancer. Regular medical check-ups are crucial for early detection and management.