Achalasia
Achalasia is a rare condition of your body’s food pipe (oesophagus) that can make swallowing food and liquids difficult.
The oesophageal muscles generally contract to push food down towards the stomach. The muscular ring at the bottom of the food pipe then opens up, allowing food to enter the stomach.
In achalasia, the oesophageal muscles do not contract successfully, and the ring of the muscle fails to open correctly, or it doesn’t open at all. Food and drink become trapped and do not reach the stomach. It’s frequently brought up again.
Symptoms
Achalasia does not always cause symptoms.
However, most persons with achalasia struggle to swallow food or drink (a condition known as dysphagia). Swallowing becomes increasingly difficult or unpleasant over time, eventually becoming impossible.
Some signs and symptoms include:
- Bringing undigested food back up.
- Choking and coughing fits.
- Heartburn.
- Chest pain.
- Chest infections that keep coming back.
- Saliva or vomit-filled drooling.
- Losing weight gradually but significantly.
- Achalasia symptoms can appear at any age.
Long-term achalasia raises the chance of getting oesophagal cancer. This indicates that you should get treatment immediately, even if the symptoms aren’t affecting you.
Causes
Achalasia is believed to occur when the nerves located in the oesophagus become damaged and fail to function correctly, causing the muscles and muscular ring to fail. The specific reason for this is uncertain.
It may be caused by a viral infection in certain people. It may also be linked to an autoimmune disorder, in which the body’s immune system damages healthy cells, tissue, and organs.
Achalasia may run in families in rare situations.
Diagnosis
You will be referred to the hospital for diagnostic testing. Achalasia can also be discovered by another type of inquiry, such as a chest X-ray.
The tests for achalasia include:
- Manometry involves introducing a thin plastic tube via your mouth or nose down your oesophagus and evaluating the muscular pressure across it at multiple points.
- A barium swallow is drinking a white liquid carrying the element barium and having X-rays taken. The barium appears clearly on an X-ray, allowing the doctor to determine the amount of time it takes to go inside your stomach.
- Endoscopy: This procedure lets the doctor view the inner layer of your oesophagus, the ring of muscle, and your stomach up close by passing a small, flexible tool called an endoscope down your throat.
Treatments for achalasia
Achalasia has no cure; however, treatments can help ease symptoms and make swallowing easier. Your doctor will discuss the risks and advantages of various options for treatment.
Medicine
Medicines like nitrates and nifedipine can help relax the muscles of your oesophagus. Although they don’t work for everyone, for some people, this makes swallowing simpler and less painful. Because the impact is only temporary, medicines may be used to relieve symptoms before doing an effective treatment. They could cause headaches, although this usually resolves with time.
Balloon dilation (muscle stretching).
A balloon is introduced into the oesophagus with a thin, long, flexible tube (endoscope) while under sedation or general anaesthesia. The balloon gets inflated to help stretch the muscle ring, which enables food to enter your stomach.
Botox injection.
The muscular ring that allows food into your stomach is injected with Botox using an instrument called an endoscope, allowing the muscle to loosen up. It is typically successful for a few months but must be repeated. This is normally painless and can be employed for short relief in those who cannot get other forms of treatment.
Surgery
Under general anaesthesia, the muscular fibres in the ring of muscle that allows food to enter your stomach are severed. This procedure, known as Heller’s Myotomy, is carried out through a tiny hole (laparoscopy). It has a chance to enhance swallowing permanently.
Following-up treatment
Both balloon dilation and surgery might result in complications such as acid reflux, heartburn, and chest pain. Medicines may be provided to help with this. It is usual for chest pain to remain following treatment. Drinking cold water could lessen the pain.
Consult a doctor if you still have trouble swallowing or are losing weight after treatment.
Reviewed by – Dr. Priyanka, MBBS MD
Page last reviewed: 17 April 2023