What is Achalasia?

Achalasia is a rare condition where your oesophagus is not able to move liquids and food down into your stomach. Oesophagus is the muscular tube whose function is to transport food from the mouth to the stomach. At the place where your oesophagus meets your stomach is a ring of muscle known as the lower esophageal sphincter (LES). This muscle relaxes (opens) to let food enter your stomach and contracts to stop stomach content from backing up into your oesophagus. In achalasia, the LES doesn’t relax, which stops food from being transported into your stomach.

What are the Symptoms of Achalasia?

Achalasia symptoms usually appear slowly and worsen over a period. Signs and symptoms of achalasia might include:

– Not able to swallow (dysphagia), which might feel like food or drink being stuck in your throat

– Disgorging food or saliva

– Heartburn

– Belching

– Recurring Chest pain

– Coughing, especially at night

– Pneumonia

– Unintended weight loss

– Intense pain or discomfort after eating

– Dry mouth and eyes

– Vomiting

What are the Causes of Achalasia?

The exact cause why your esophageal muscles fail to contract and relax is not yet known but a theory suggests that achalasia is an autoimmune disease (your body attacks itself) and a virus triggers it. The nerve cells in the muscle layers of the walls of your oesophagus and the lower esophageal sphincter (LES) are attacked by your immune system. Your nerve cells, controlling muscle function, gradually degenerate for reasons that are not unknown. This causes excessive contractions in the lower esophageal sphincter (LES). If you are suffering from achalasia, then your lower esophageal sphincter (LES) fails to relax and food and liquids are not able to pass through your oesophagus into your stomach.

A rare form of achalasia might be inherited and more research is required to know more about what exactly causes achalasia.

What are the Risk Factors of Achalasia?

Though the exact causes of achalasia are not yet known, there might be some risk factors that increase the risk of developing this condition, including:

– Family history or genetics

– Harm to the nerves in your oesophagus or lower esophageal sphincter (LES)

– Viral infections might trigger an autoimmune response, particularly if you have a higher genetic risk of the condition.

– Chagas disease, a rare parasitic infection that usually affects people in Mexico, South America, and Central America, has also been connected to achalasia.

– A spinal cord injury

– Having endoscopic sclerotherapy for treating bleeding or enlarged veins

– Age as it has been noticed that achalasia is more common in middle age and older adulthood

What are the Complications of Achalasia?

Some complications of achalasia are because food backs up into your oesophagus and then is drawn into your windpipe, then leading to your lungs. These complications mostly include:

– Pneumonia.

– Lung infections (pulmonary infections).

Other complications include:

– Having achalasia increases your risk of esophageal cancer.

Complications of achalasia treatments include:

– A hole in the oesophagus.

– Not able to cure achalasia symptoms completely and their reoccurrence.

– Gastroesophageal reflux disease.

– Bloating.

How Achalasia is Diagnosed?

Achalasia might be mistaken, ignored, or misdiagnosed because its symptoms are the same as various other digestive conditions. To diagnose achalasia, your doctor is likely to do a few tests including:

– Esophageal manometry

The rhythmic muscle contractions in your oesophagus when you swallow, the coordination and force exerted by the oesophagus muscles are measured in this test along with how well your lower esophageal sphincter relaxes or opens while swallowing. This test is the most effective to determine the type of motility problem you may have.

– X-rays of your upper digestive system

X-rays are carried after you are being made to drink a chalky liquid that fills and coats the inside lining of your digestive tract. The coating helps your doctor detect a silhouette of your oesophagus, stomach, and upper intestine. You might be told to swallow a barium pill that might be helpful to show any kind of blockage of the oesophagus.

– Upper endoscopy

During endoscopy, your doctor will insert a thin, flexible tube loaded with a light and camera (endoscope) into your throat, to see the inside of your stomach and oesophagus. Endoscopy might be used to find a partial blockage of the oesophagus if your symptoms are showing that possibility. Endoscopy is also used to collect a sample of tissue (biopsy) which is used to look for complications of reflux like Barrett’s oesophagus.

What are the Treatment Options Available for Achalasia?

The treatment procedures are based on your age, health condition, and the severity of the condition. The treatment options for achalasia mostly include:

– Minimally Invasive Surgery

The surgery done to treat achalasia is known as laparoscopic esophagostomy or laparoscopic Heller myotomy. During this minimally invasive surgery, a thin, telescopic-like instrument known as an endoscope is inserted via a small incision. The endoscope is linked to a small video camera – tinier than a dime –that shows a view of the operative site on video monitors placed in the operating room. The muscle fibres of the LES are cut in this operation. Another process called partial fundoplication is used to prevent gastroesophageal reflux, a side effect of the Heller myotomy process.

A minimally invasive alternative to laparoscopic Heller myotomy known as peroral endoscopic myotomy (POEM) is used sometimes to treat achalasia. During this procedure, a knife is used to cut the muscles on the side of the oesophagus, the LES, and the upper portions of the stomach, and the cuts in these parts loosen the muscles, letting the oesophagus to empty like it usually should, which helps to pass food down into your stomach.

Balloon dilation

– It’s a non-surgical procedure, where you’ll be put under light sedation and a specially designed balloon is inserted via the LES which will be then inflated and this process helps in relaxing the muscle sphincter, thus allowing food to enter your stomach. Balloon dilation is generally used as the first treatment option in people for whom surgery did not work.

You might have to go through various dilation treatments every few years to manage and control your symptoms and maintain relief.

Medication

If you are not suitable for balloon dilation or surgery or you have selected not to use these procedures, you might be benefitted from Botox injections. Botox is a protein made by bacteria that leads to botulism. When injected in very small amounts into muscles it helps in relaxing spastic muscles. It functions by blocking the signal from the nerves to the sphincter muscles that tell them to contract. Injections are required to be repeated to control the symptoms.

Other medicines given to treat this condition include nifedipine or isosorbide. These medications help relax the spastic esophageal muscles by lowering LES pressure. These treatments provide only short-term relief of your symptoms and are less effective than surgery or balloon dilation.

Esophagectomy

When other treatment options are not working then removing your oesophagus is a last resort treatment.

Living with Achalasia

First, you have to understand that achalasia is a lifelong condition and you need to have realistic expectations about the results of the various treatment procedures. There is no treatment available to cure achalasia but the symptoms can be managed and controlled. You should discuss all treatment options available and their success rate for controlling symptoms with your doctor along with the requirement for repeat procedures and their frequency, risks, and benefits. If treatments are done properly then you can lead a normal life even with having this condition.

Whom to Consult?

The symptoms of achalasia are the same as many other digestive disorders and it’s one of the main reasons it is mostly left undiagnosed and if left undiagnosed and not treated, it can cause many complications, some of which can be life-threatening also. If you notice symptoms of achalasia, then you should not ignore them and seek immediate medical care. Your doctor will take a few tests to detect whether it’s a digestive disorder or achalasia and then start your treatment plan according to the outcome of tests and the diagnosis.