Achalasia

Definition

Achalasia is a relatively rare disorder of the smooth muscle of the esophagus. The esophagus is a muscular tube that carries food and liquids from the mouth to the stomach. Achalasia makes it difficult for food and liquid to pass into the stomach from the esophagus.

Causes

There is a muscle called the lower esophageal sphincter (LES). This is where the esophagus meets the stomach. When not swallowing, the LES remains closed to keep food, liquid, and stomach acid from moving back into the esophageal tube. When swallowing, nerve signals tell muscles to contract to push food down the esophagus (an action called peristalsis). This allows the LES to open.

In people with achalasia, the nerve cells in the lower esophageal tube and the LES do not work correctly. This results in:

• Missing peristaltic (muscular) activity
• Failure of the LES to open completely

While achalasia is associated with the loss of nerve cells in the esophagus, the cause of this process is unknown.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Because the exact cause of achalasia is unknown, risk factors are unknown.

Symptoms

Symptoms of achalasia can occur between the ages of 25 and 60. Symptoms rarely develop in children. Symptoms tend to be mild at first, and then grow worse over months or years. The main symptom is difficulty swallowing solids and, as the disorder progresses, liquids. As many as 70% to 97% of patients with achalasia have difficulty swallowing both solids and liquids.

Other symptoms may include:

• Discomfort or pain in the chest , especially after meals
• Coughing, especially when lying down
• Heartburn
• Weight loss (as the disorder progresses)
• Vomiting or regurgitating food or liquids. This may occur during sleep. This can cause a person to inhale food particles or liquid, which can lead to aspiration pneumonia and other respiratory infections.

Heartburn / Reflux Disease

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Diagnosis

The doctor will ask about your symptoms and medical history and perform a physical exam. Tests may include:

• Manometry—A tube is inserted down the throat to test the pressure in the esophagus and the stomach when swallowing.
• Esophagram—X-rays are taken of the esophagus while you swallow barium (a thick liquid that lights up on x-rays).
• Upper gastrointestinal endoscopy (esophagoscopy)—The esophagus is viewed directly through a fiberoptic tube to look for other causes of the symptoms.

Treatment

The goal of treatment is to make it easier for the LES to open. Treatment may include:

In mild cases, certain medications may help relieve symptoms temporarily. Drugs that reduce LES pressure include:

• Nifedipine
• Nitroglycerin

Prevention

There are no guidelines to prevent achalasia because the cause is usually not known.