Description

Achalasia is a swallowing condition that affects the tube that connects the mouth and the stomach, called the esophagus. Damage to the nerves that make it difficult for the muscles of the esophagus to push food and liquid in the stomach. Food, then collects in the esophagus, sometimes the fermentation and washing again in the mouth. This fermented food can have a bitter taste.

Achalasia is a fairly rare condition. Some people confuse it with the gastroesophageal reflux disease (GERD). However, in achalasia, the food comes from the esophagus. In GERD, the material comes from the stomach.

There is No cure for achalasia. Once the esophagus is damaged, the muscles cannot work properly again. But the symptoms can be managed with endoscopy, minimally invasive therapy, or surgery.

Symptoms

Achalasia in general, symptoms appear gradually and gets worse with time. Symptoms may include:

  • Difficulty swallowing, called dysphagia, which may feel like the food or the drink is stuck in the throat.
  • Ingestion of food or saliva that flows back into the throat.
  • Heartburn.
  • Belching.
  • Pain in the chest that comes and goes.
  • Coughing at night.
  • Pneumonia of the obtaining of food into the lungs.
  • The loss of weight.
  • Vomiting.

Causes

The exact cause of achalasia is poorly understood. The researchers suspect that it may be caused by a loss of nerve cells in the esophagus. There are theories about what causes this, but a viral infection or autoimmune responses are possibilities. Very rarely, achalasia can be caused by an inherited genetic condition or infection.

Risk factors

Risk factors for achalasia are:

  • Age. Although achalasia can affect people of all ages, it is most common in people between the ages of 25 and 60 years of age.
  • Certain medical conditions. The risk of achalasia is higher in people with allergic disorders, adrenal insufficiency, or Allgrove syndrome, a rare autosomal recessive genetic condition.

Diagnosis

Achalasia may be overlooked or misdiagnosed because the symptoms are similar to other digestive disorders. For the test of achalasia, a health professional is likely to recommend:

  • The esophageal manometry. This test measures the contractions of the muscles in the esophagus during swallowing. It also measures how well the lower esophageal sphincter is opened during a swallow. This test is most useful when deciding which type of swallowing condition that you may have.
  • X-rays of the upper part of the digestive system. X-rays are taken after you drink a chalky liquid called barium. The barium coats the inside of the lining of the digestive tract and filled with the organs of digestion. This layer allows a health professional to see a silhouette of your esophagus, stomach and the upper intestine. In addition to drinking the liquid, the barium swallow pill can help show an obstruction in the esophagus.
  • The upper gastrointestinal endoscopy. An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine your upper digestive system. Endoscopy can be used to find a partial obstruction of the esophagus. Endoscopy can also be used to collect a sample of tissue, called a biopsy, to be tested for complications of reflux, such as Barrett's esophagus.
  • Functional luminal imaging probe (FLIP) of the technology. FLIP is a new technique that can help to confirm a diagnosis of achalasia if other tests are not sufficient.

Treatment

The treatment of achalasia focuses on relaxation and stretching to open the lower esophageal sphincter, so that food and liquid can move more easily through the digestive tract.

The specific treatment depends on your age, health status, and the severity of achalasia.

The non-surgical treatment

Non-surgical options include:

  • Pneumatic dilatation. During this outpatient procedure, a balloon is inserted in the center of the esophageal sphincter and inflated to enlarge the opening. Pneumatic dilatation may be necessary to repeat if the esophageal sphincter does not open. Almost a third of the patients treated with balloon dilation necessary to repeat the treatment in a period of five years. This procedure requires sedation.
  • OnabotulinumtoxinA (Botox).This relaxing muscle can be injected directly into the esophageal sphincter with a needle during an endoscopy. The injections may be necessary to repeat, and repeat injections may make it more difficult for the surgery to be performed later if necessary. Botox is generally only recommended for people who may not have pneumatic dilation or surgery due to age or health in general. Botox injections typically last no more than six months. A strong advance in the injection of Botox can help to confirm a diagnosis of achalasia.
  • Of medicine. Your doctor might suggest to muscle relaxants such as nitroglycerin (Nitrostat), or nifedipine (Procardia) before eating. These medications have limited the effect of the treatment and severe side effects. The drugs are usually considered only if you are not a candidate for pneumatic dilatation or surgery, and Botox has not helped. This type of therapy is rarely indicated.

OnabotulinumtoxinA (Botox). This relaxing muscle can be injected directly into the esophageal sphincter with a needle during an endoscopy. The injections may be necessary to repeat, and repeat injections may make it more difficult for the surgery to be performed later if necessary.

Botox is generally only recommended for people who may not have pneumatic dilation or surgery due to age or health in general. Botox injections typically last no more than six months. A strong advance in the injection of Botox can help to confirm a diagnosis of achalasia.

Surgery

Surgical options for the treatment of achalasia are:

  • The Heller myotomy.A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows the food to pass more easily in the stomach. The procedure can be performed using a minimally invasive technique which is called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop the disease gastroesophageal reflux disease (GERD). To avoid problems in the future with GERD, a surgeon can perform a procedure known as fundoplication, at the same time, as a Heller myotomy. In fundoplication, your surgeon wraps the upper part of the stomach around the lower esophagus to create an anti-reflux valve, the prevention of acid into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.
  • Peroral endoscopic myotomy (POEM).In the POEM procedure, the surgeon uses an endoscope inserted through the mouth and the throat, to create an incision in the inner lining of the esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter. POEM may also be combined with, or followed by most of fundoplication to help prevent GERD. Some patients who have POEM and develop GERD after that the procedure is treated with daily medication that you take by mouth.

The Heller myotomy. A Heller myotomy involves cutting the muscle at the lower end of the esophageal sphincter. This allows the food to pass more easily in the stomach. The procedure can be performed using a minimally invasive technique which is called a laparoscopic Heller myotomy. Some people who have a Heller myotomy may later develop the disease gastroesophageal reflux disease (GERD).

To avoid problems in the future with GERD, a surgeon can perform a procedure known as fundoplication, at the same time, as a Heller myotomy. In fundoplication, your surgeon wraps the upper part of the stomach around the lower esophagus to create an anti-reflux valve, the prevention of acid into the esophagus. Fundoplication is usually done with a minimally invasive procedure, also called a laparoscopic procedure.

Peroral endoscopic myotomy (POEM). In the POEM procedure, the surgeon uses an endoscope inserted through the mouth and the throat, to create an incision in the inner lining of the esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.

POEM may also be combined with, or followed by most of fundoplication to help prevent GERD. Some patients who have POEM and develop GERD after that the procedure is treated with daily medication that you take by mouth.

Symptoms and treatment of Achalasia