What
is Achalasia?
Achalasia is an uncommon esophageal disorder primarily characterized
by the failure of the lower esophageal sphincter to relax. Abnormal peristalsis ensues resulting
in the impairment of the ability to push food into the stomach. If left untreated, persistent
achalasia may cause the esophagus to become enlarged and eventually stop functioning. Chances
of developing esophageal cancer increase for patients with untreated achalasia.
Causes of achalasia are not well understood. However, damage to the nerves of the esophagus
from viral, parasitic, infections, or heredity causes have been implicated.
Achalasia is seen
primarily in young women and middle-aged men and women. It may also be seen in elderly people
who experience recurrent respiratory infections.
What symptoms will
I experience if I have Achalasia?
- Difficulty swallowing
- Regurgitation of food
- Chest pain/pressure that may increase after eating, or may radiate
to the back, neck and arms
- Weight loss
- Heartburn
- Chronic cough
How is it diagnosed?
The two most common diagnostic tests for achalasia are the barium
swallow and esophageal
manometry. A barium swallow is generally used to determine the possible presence of achalasia
and an esophageal manometry will follow to confirm the results. A barium swallow involves
the ingestion of barium after which a series of x-rays are taken. The barium coating allows
your physician to see if your esophagus shows structural changes consistent with achalasia.
The test evaluates any anatomic reasons for the symptoms. An esophageal manometry involves
passing a small tube or catheter through your nose into the esophagus and stomach. The tube
is then slowly pulled back through the esophagus and pressure readings are taken at intervals
along the esophagus. This test measures the ability of your lower
esophageal sphincter to
relax and the ability of your esophagus to squeeze food into the stomach. An upper gastrointestinal
endoscopy may be preformed to exclude the presence of tumors which can cause secondary forms
of achalasia.
What is the treatment
process for Achalasia?
There are several common methods used in treating achalasia. Your physician may
recommend one or more of these treatments to you.
- Surgery: The surgical procedure used
to treat achalasia is called the Heller
myotomy. This procedure is the treatment of choice for
many patients. This procedure is performed laparoscopically with minimally invasive technologies.
During this procedure, the lower esophageal sphincter muscle is cut so that food can pass
easily from the esophagus into the stomach. Most patients experience minimal discomfort and
go home in 24 to 48 hours after surgery.
- Pneumatic Dilation: While under sedation,
an endoscope is passed through your mouth and into your stomach. Under fluoroscopy, a small
balloon is then inflated. The expansion causes the lower
esophageal sphincter muscle to stretch and weaken, allowing food to pass easily into
the stomach. Seventy-five to 80 percent of patients treated with pneumatic dilation experience
relief from their symptoms, however dilation does sometimes need to be repeated and there
is a small risk of tearing the esophagus.
- Botulinum Toxin: Botulinum toxin (Botox) can be injected
into the lower esophageal
sphincter, which paralyzes and then relaxes the muscle, allowing
food to pass more freely through the esophagus. Under endoscopic guidance, Botox may be injected.
While the results may be good initially, the procedure provides only temporary relief and
must be periodically repeated to maintain control of symptoms. It is best suited for patients
who are deemed unsuitable for surgery or balloon dilation due to other medical conditions.
What happens if Achalasia goes untreated?
If achalasia is not treated, the esophagus will become progressively enlarged and eventually
will be completely non-functional. The treatment of long-standing achalasia is complicated
without removal of the esophagus. There is an increased chance of developing esophageal
cancer in patients with untreated achalasia.
Where can I learn more about Esophageal Cancer?
Where can I find a support group?
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