Doctor explains Achalasia | Definition, causes, symptoms, treatment, surgery

Achalasia is a rare esophageal disorder that can significantly impact your quality of life. Understanding this condition is crucial for those affected, as well as for their families and caregivers. In this article, I will delve into the key aspects of achalasia, including its causes, symptoms, diagnosis, treatment options, and lifestyle modifications that can help manage the condition.

What is Achalasia?

Achalasia is characterized by the inability of the lower esophageal sphincter (LES) to relax properly, which prevents food and liquids from passing into the stomach. The esophagus, often referred to as the food pipe, is a muscular tube that transports food from the mouth to the stomach. In a healthy individual, the LES relaxes to allow food to enter the stomach and then closes to prevent the backflow of stomach contents. However, in individuals with achalasia, this muscle fails to relax, leading to food becoming trapped in the esophagus.

Causes of Achalasia

The exact cause of achalasia remains unclear, but several theories exist. One prominent theory suggests that it may be an autoimmune disorder triggered by a viral infection, where the body mistakenly attacks its own nerve cells in the esophagus. In some cases, genetic factors may also play a role, indicating that achalasia can run in families. Further research is needed to fully understand the underlying mechanisms of this condition.

Symptoms of Achalasia

Symptoms of achalasia typically develop gradually and can persist for months or even years. The most common early symptom is dysphagia, or difficulty swallowing. Patients often report a sensation of food being stuck in the esophagus, which can lead to regurgitation of undigested food. Other symptoms may include:

• Chest pain that may come and go
• Heartburn
• Nighttime cough
• Weight loss due to difficulty eating

It is important to note that these symptoms can lead to complications, such as aspiration pneumonia, where food particles enter the lungs, and an increased risk of esophageal cancer, particularly if the condition remains untreated.

Diagnosing Achalasia

Diagnosing achalasia typically involves a combination of tests:

1. Barium Swallow: In this test, the patient swallows a barium solution, which coats the esophagus and allows for clear imaging via X-rays. This test can reveal narrowing at the LES.
2. Upper Endoscopy: A flexible tube with a camera is inserted into the esophagus to visualize its interior. This procedure helps rule out other conditions, such as cancer.
3. Manometry: This is considered the gold standard for diagnosing achalasia. It measures the pressure and timing of esophageal muscle contractions and assesses the relaxation of the LES.

Treatment Options for Achalasia

Treatment for achalasia aims to relieve symptoms by allowing food to pass more easily into the stomach. Options include both non-surgical and surgical interventions:

Non-Surgical Treatments

• Balloon Dilation: This procedure involves inserting a balloon through the LES and inflating it to widen the opening. It can provide significant symptom relief for many patients.
• Botulinum Toxin Injections: Botox can be injected into the LES to help relax the muscle. While effective for some, the effects are temporary, requiring repeat injections every 6 to 12 months.
• Medications: Certain medications can help lower the pressure in the LES, but they are generally less effective than surgical options.

Surgical Treatments

• Laparoscopic Esophagomyotomy: This surgical procedure involves cutting the muscle fibers of the LES to allow easier passage of food. It is highly effective but may lead to gastroesophageal reflux in some patients.
• Peroral Endoscopic Myotomy (POEM): A minimally invasive alternative to traditional surgery, POEM involves cutting the muscle fibers through the esophagus using an endoscope.
• Esophagectomy: In severe cases where other treatments fail, the esophagus may be surgically removed. This is considered a last resort.

Lifestyle Modifications

Managing achalasia often requires lifestyle adjustments. Here are some tips to help improve your quality of life:

• Eat Smaller Bites: Cutting food into small pieces can make swallowing easier.
• Stay Upright While Eating: Eating in an upright position can help gravity assist in moving food down the esophagus.
• Avoid Lying Flat: This can increase the risk of aspiration. Elevate your head while sleeping to reduce this risk.
• Limit Solid Foods at Night: Avoid eating solid foods close to bedtime to minimize nighttime discomfort.

Conclusion

Achalasia is a complex condition that requires a comprehensive approach to management. If you or someone you know is experiencing symptoms of achalasia, it is essential to consult with a healthcare provider for an accurate diagnosis and to discuss the most appropriate treatment options. With the right care and lifestyle adjustments, individuals with achalasia can lead fulfilling lives despite the challenges posed by this disorder. Please note this is a general educational resource only - and not individual clinical advice. For all individual clinical questions always speak to your own healthcare provider.