Achalasia

Achalasia is a condition where the esophageal muscles are unable to push food or drink into the stomach. This condition can cause sufferers to experience symptoms such as difficulty swallowing, food coming back up into the esophagus, and weight loss.

When a person eats or drinks, the ring of muscle at the bottom of the esophagus (lower esophageal sphincter / LES) contracts to push food or drink deeper. Next, the LES relaxes so that food or drink can enter the stomach.

In achalasia, the LES becomes stiff and fails to open properly. This causes food or drink to build up in the lower esophagus and sometimes back up into the upper esophagus.

Although both cause food to rise into the throat, achalasia is different from acid reflux disease (GERD). GERD occurs because the LES is too weak so that the esophageal muscle ring cannot close.

Achalasia is a rare disease. It is estimated that this condition occurs in 1 in 100,000 people. However, achalasia can affect people of all ages, both men and women.

Causes of Achalasia

It is not known what causes achalasia, but it is thought to be associated with a number of the following conditions:

• Autoimmune disease
• Family history
• Decreased nerve function
• Virus infection

In addition to the above conditions, achalasia can also occur as a complication of Chagas disease , gastric cancer , and lymphoma.

Risk factors for achalasia

Achalasia can happen to anyone. However, there are a number of factors that can increase a person’s risk of experiencing achalasia:

• Aged 30–60 years
• Having a spinal injury
• Undergoing therapy to treat varicose veins (sclerotherapy)
• Suffering from Down syndrome

Achalasia Symptoms

Symptoms of achalasia appear gradually. Over time, the function of the esophagus in people with achalasia will become weaker and the following symptoms will appear:

• Frequent burping
• Difficulty swallowing or dysphagia
• Weight loss
• Food comes back up into the esophagus or regurgitation
• Hot sensation in the chest (heartburn)
• Chest pain that comes and goes
• Cough at night
• Vomit

When to see a doctor

See a doctor immediately if you experience the above symptoms. If left untreated, untreated achalasia can increase the risk of the sufferer developing esophageal cancer .

If you have been diagnosed with achalasia, talk to your doctor about proper diet. You should also see your doctor if your symptoms persist despite medical treatment.

Symptoms of achalasia are similar to symptoms of other digestive disorders, such as GERD. By checking with your doctor, you will get the right diagnosis and treatment.

Achalasia Diagnosis

To diagnose achalasia, the doctor will first ask about the patient’s symptoms and medical history. After that, the doctor will perform a physical examination of the patient’s ability to swallow food or drink.

Next, the doctor can carry out supporting examinations, such as:

• Esophagography, to obtain detailed images of the esophagus, stomach and intestines by drinking barium fluid.
• Manometry, to measure the flexibility and strength of contraction of the esophageal muscles during swallowing.
• Endoscopy, to examine the condition of the walls of the esophagus and stomach.

Achalasia Treatment

Treatment for achalasia aims to relax the LES muscle so that food and drink can easily enter the stomach. Treatment methods can be done with non-surgical measures or surgical procedures, as explained below.

Non-surgical measures

A number of non-surgical measures that can be taken to treat achalasia are:

• Pneumatic dilation
  Pneumatic dilation is a procedure to widen the esophagus by inserting a special balloon into the narrowed part of the esophagus. This procedure needs to be done approximately five times to get the best results.
• Botulinum toxin injection Botulinum toxin (botox) injections serve to relax the esophageal muscles for patients who cannot undergo pneumatic dilation . The effects of botox injections only last a maximum of 6 months so they need to be repeated.
• Administration of muscle relaxants Medications
  used include nitroglycerin and nifedipine. Muscle relaxants are given to patients who cannot undergo pneumatic dilation or surgery, or when Botox injections are not effective in treating achalasia.

Surgical procedures

Some surgical procedures that doctors can choose to treat achalasia are:

• Heller myotomy This procedure is performed by cutting the LES muscle using laparoscopic techniques . Heller myotomy can be performed in conjunction with a fundoplication procedure, to reduce the risk of future GERD attacks.
• Fundoplication
  Fundoplication is a procedure to wrap the lower part of the esophagus with the upper part (fundus) of the stomach. The goal is to prevent stomach acid from rising into the esophagus.
• Peroral endoscopic myotomy (POEM)
  POEM is a procedure to cut the LES muscle directly from the inside of the mouth. This procedure is done with the help of a camera tube inserted through the mouth (endoscope).

Achalasia Complications

Untreated achalasia can lead to a number of complications, namely:

• Aspiration pneumonia , which occurs due to food or drink entering the lungs, causing infection.
• Inflammation of the lining of the esophagus or throat (esophagitis)
• Tearing of the esophageal wall (esophageal perforation)
• Esophageal cancer

Achalasia Prevention

Achalasia is difficult to prevent. However, if you have achalasia, there are several things you can do to prevent the symptoms from appearing, namely:

• Drink lots of water while eating
• Chew food until it is completely smooth before swallowing.
• Avoid consuming foods or drinks that can trigger a hot sensation in the chest (heartburn), such as chocolate, oranges, and spicy foods.
• Eat small portions but often, rather than eating infrequently but eating large portions at once.
• Avoid eating at night, especially close to bedtime.
• Support your head with a pillow when sleeping, to prevent stomach acid from rising into the esophagus.
• Do not smoke

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