Conditions:

Achalasia

Definition 

Achalasia is a disorder of the oesophagus (the tube that carries food from the mouth to the stomach). The oesophagus is less able to move food toward the stomach, and the valve from the oesophagus to the stomach does not relax as much as it needs to during swallowing. This relaxation is needed to allow food to enter the stomach.

Causes, incidence, and risk factors 

The main abnormality in achalasia is a failure of the lower oesophageal sphincter (a muscular ring at the junction of the oesophagus and stomach) to relax during swallowing. The disorder is characterized by loss of the wave-like contraction of smooth muscles that forces food through the digestive tract. (These contractions are called peristalsis.)

Another part of the disorder is lack of nervous stimulation to the oesophagus. Causes include damage to the nerves to the oesophagus, parasitic infection, cancers, and hereditary factors. Achalasia is a rare disorder, may occur at any age, but is most common in middle-aged or older adults.

Symptoms 

• Difficulty swallowing liquids and solids
• Regurgitation of food
• Chest pain which may increase after eating or may radiate to the back, neck, and arms
• Unintentional weight loss
• Heartburn
• Cough

Signs and tests 

An upper GI x-ray test or barium esophagogram may show absence of peristalsis, a dilated proximal oesophagus, and a narrowing at the bottom of the oesophagus. The diagnosis is confirmed with oesophageal manometry. Physical examination may show signs of anaemia.

Treatment 

The approach to treatment is to reduce the pressure at the lower oesophageal sphincter. This may be achieved by manipulating the lower oesophagus sphincter with special instruments.

Therapy usually involves dilation of the lower sphincter or injection with botulinum toxin to paralyse it and prevent spasms. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower oesophagus sphincter.

Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.

Expectations (prognosis) 

Surgical outcomes are good -- dilation alone often results in only temporary improvement in symptoms.

Complications 

Tearing (perforation) of the oesophagus
Regurgitation of acid or food from the stomach into the oesophagus (reflux)
Aspiration of food contents into the lung that can cause pneumonia
Calling your health care provider 

Call your doctor if you have persistent difficulty swallowing or painful swallowing, or if symptoms persist despite treatment for achalasia.

Prevention 

Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

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