Achalasia: Symptoms, Risk Factors, Diagnosis, Treatment

Medically Reviewed by Dr. K on 13 May 2022.

What Is Achalasia?

Achalasia occurs when the pathways that transport food to your stomach do not function properly. When you drink, two things would happen in order for food and liquids to move from your mouth to your stomach. The oesophagus, the tube that transports food to the stomach, must first squeeze and relax to carry the food along. When the food enters the stomach, a small muscle flap or valve at the bottom of the oesophagus must open to allow the food to pass through.

Both of these processes are ineffective if you have achalasia. Food cannot be pushed down the oesophagus. In addition, the valve does not fully open. Food is stuck at the base of the oesophagus, similar to a clogged drain, and washes back into the mouth.

Achalasia is an unusual condition. It would affect around 1 in 100,000 people. It may take years for signs to appear, and certain people neglect them for years before seeking medical help. While there is no cure for the disease, therapy will help you deal with it.

Achalasia Causes

Experts remain baffled as to whether achalasia occurs. However, the following are potential causes:

  • Hereditary – passed down from your parents (genetics)
  • Autoimmune issues
  • A viral infection
  • Loss of nerve function (neurodegenerative)

Achalasia Risk Factors

Achalasia can affect people of any ethnicity. It affects both men and women similarly. It often affects adults between the ages of 30 and 60, but it may also affect teenagers. Achalasia is a condition that may occur in individuals with Down syndrome.

Achalasia Symptoms

Trouble swallowing liquids and solid food is the most common symptom of achalasia.

The following are some of the symptoms that people with the disorder can experience:

  • Chest pain especially after eating
  • Food coming back up into the throat
  • Heartburn
  • Belching
  • Weight loss
  • Nighttime coughing
  • Vomiting
  • Pneumonia from breathing food into the lungs

If you eat within four hours of going to bed, the symptoms can get worse.

Achalasia Diagnosis

Since the symptoms of achalasia are so similar to those of heartburn, your doctor may first treat you for it. If it doesn't succeed, you'll most likely be tested for achalasia.

A special instrument called an endoscope can be used to see down into the throat. The doctor can see down the oesophagus thanks to a small camera attached to a long tube.

The barium swallow test is a popular achalasia screening test. A measure called manometry is also useful. When you take sips of water, a doctor inserts a small tube down your throat to assess the strength of your oesophageal muscles. It even assesses the efficiency of your stomach valve.

: Signs, Symptoms, Diagnosis and Prevention

Achalasia Treatment

Surgery

The most effective achalasia treatment is surgery. The majority of patients will experience long-term recovery from their problems after surgery.

A Heller myotomy is the most common treatment. Most of the time, a scope with a monitor and a lamp, as well as other instruments, is used. The doctor makes some small incisions in the abdomen and then uses surgical instruments to access the section that needs to be operated on. The operation's aim is to open up a section of the lower oesophagus, making swallowing easier. It is normally successful.

Peroral endoscopic myotomy, or POEM, is another surgical option. Doctors don't have to make any cuts outside the body for this technique. An endoscope (a little instrument with a camera on the end) is inserted into the mouth and down the throat instead. They make a little cut in the internal lining of the oesophagus until they've seen inside. They break through the inner muscle of the lower oesophagus and tunnel into it to meet the inner muscle of the lower oesophagus, where they make another cut. This makes chewing a lot smoother.

Both of these operations are safe. However, they can occasionally induce acid reflux.

Your doctor will talk to you about which treatment is better for you.

Other Treatments

Achalasia does not require surgery. There are certain things that can improve, but they rarely perform as well as they can. It's also possible that you'll need to go in for several treatments.

Some options are:

Muscle-relaxing drug injections Botox (botulinum toxin) is injected into the strong oesophageal muscles by the doctor. This momentarily relaxes the muscles, allowing you to swallow normally.

Pneumatic dilation – stretching the oesophagus. To stretch the tense muscles, the doctor places a bubble in the valve between the oesophagus and the stomach and inflates it. It's possible that you'll have to repeat this technique many times before it works.

Medication. Nitrates and calcium channel blockers are two types of medications that calm the LES muscles. These medications can help people with achalasia feel better.

Your doctor can even inject a drug into the oesophagus to aid in the digestion of food. However, it only lasts 6 to 12 months.

The right care for you is determined by a variety of factors. Your doctor will assist you in determining what you need.

Living with Achalasia

There is no particular diet for this illness, but you may find that some foods move into your oesophagus more quickly on your own.

It's possible that drinking more water with meals would help. Colas and other carbonated beverages can also benefit. The carbonation seems to aid in the passage of food into the oesophagus.

A liquid diet could be your best bet for a while if your achalasia is serious. When you're not eating solid foods, speak to the doctor about having the nutrition you need. If you lose a lot of weight, alert your doctor right away because it might indicate malnutrition.

Achalasia puts some patients at risk for oesophageal cancer. As a result, it's important that you see the doctor on a daily basis.

Sources

Referenced on 2.3.2021:

  1. Pandolfino, J. JAMA, May 12, 2015.
  2. Vaezi, M. American Journal of Gastroenterology, August 2013.
  3. Mayo Clinic: “Achalasia: Definition.”
  4. Genetic and Rare Diseases Information Center, National Institutes of Health: “Achalasia.”
  5. The University of Chicago Medicine: “Achalasia.”
  6. Memorial Sloan Kettering Cancer Center: “Diagnosis & Treatment of Achalasia.”
  7. The Society of Thoracic Surgeons: “Achalasia and Esophageal Motility Disorders.”
  8. Bhayani, N. Annals of Surgery, June 2014.
  9. Washington University School of Medicine in St. Louis: “Heller Myotomy for Achalasia.”
  10. American Cancer Society: “What Are the Risk Factors for Cancer of the Esophagus?”
  11. The Society of Thoracic Surgeons: “Achalasia and Esophageal Motility Disorders.”
  12. Pandolfino, J. Journal of the American Medical Association, May 12, 2015.
  13. Genetic and Rare Diseases Information Center, National Institutes of Health.
  14. Singapore Medical Journal: “Achalasia and Down syndrome: a unique association not to be missed.”
  15. American Journal of Gastroenterology: “ACG Clinical Guideline: Diagnosis and Management of Achalasia.”
  16. https://www.webmd.com/digestive-disorders/achalasia-what-to-know

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