Achalasia

Achalasia, or esophageal achalasia, is a rare disorder of the esophagus, the tube that carries food from the mouth to the stomach.

At the point where the esophagus meets the stomach is a ring-like muscle called the lower esophageal sphincter (LES). The LES normally relaxes during swallowing to allow food from the esophagus to enter the stomach. When the LES fails to relax, the condition is called achalasia.

Caused by damage to the nerves of the esophagus, achalasia is most common in middle-aged or older adults, but may occur at any age. In some people, the condition may be inherited.

Early in achalasia, there is inflammation in the LES, especially around the nerves, when viewed under a microscope. As the disease progresses, the nerves - particularly those that cause the LES to relax - begin to degenerate and ultimately disappear. Eventually, muscle cells also degenerate. The result of these changes is an LES that cannot relax and muscles in the lower part of the esophagus that do not contract normally. In time, the body of the esophagus stretches and becomes enlarged (dilated).

Prevention

Pecause the cause of achalasia is not known, the condition is not preventable. Early treatment, however, can lessen the chance of complications.

Symptoms

Consistent difficulty in swallowing both solid food and liquids is the most common symptom of achalasia.

Chest pain, which can mimic heart pain or be felt in the back, neck and arms and which may increase after eating is also a symptom.

Regurgitation of food that is trapped in the esophagus can occur especially in patients with a dilated esophagus.

Heartburn, cough and unintentional weight loss are also symptoms of achalasia.

If you are experiencing any of these symptoms and think you may have achalasia, be sure to see your primary physician or gastroenterologist for a complete diagnosis.

Treatment

Medication

Medication that helps the LES relax can sometimes be used to treat achalasia, particularly early in the disease. However, most patients do not have a reduction in symptoms with medication, and those who do usually find that relief is only short-term.

Botulinum toxin

An injection of botulinum toxin that weakens the LES is a quick, nonsurgical treatment for achalasia, but the results are often only temporary. The treatment is performed using a lighted, flexible tube inserted through the mouth called an endoscope and can be a good option for elderly patients or those for whom surgery is high risk.

Surgery

Surgery for the treatment of achalasia, called an esophagomyotomy, can often be done laparoscopically. Laparoscopic surgery involves a number of small incisions made in the upper abdomen, into which the surgeon inserts a long, thin camera and surgical instruments. Because of excellent results, a short hospital stay, and a fast recovery time, many surgeons consider laparoscopic surgery to be the preferred approach.

During the esophagomyotomy, while the patient is under general anesthesia, the LES is cut, allowing it to open more easily. The procedure is more reliable and has a higher success rate than dilation and results in a greater reduction in pressure.

Reflux of acid into the esophagus (gastroesophageal reflux disease or GERD) is a possible side effect of surgery. Modification of the procedure so that the LES isn't completely cut can prevent this, or the esophagomyotomy can be combined with anti-reflux surgery (fundoplication).

The information provided on these educational pages is for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a medical condition. And, if experiencing a medical emergency call 9-1-1.

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