Achalasia is a digestive system disorder characterized by the accumulation of swallowed food in the esophagus due to the failure of the sphincter between the esophagus and stomach to open properly. Normally, the lower esophageal sphincter (LES) opens when swallowing, but in individuals with achalasia, nerve damage or dysfunction of the sphincter muscle prevents this opening.
This condition leads to difficulty swallowing (dysphagia) and a sensation of food getting stuck in the esophagus, causing discomfort in the chest. Since the risk of aspiration increases, swallowed food may enter the respiratory tract, leading to a choking hazard.
Although achalasia primarily affects middle-aged and older adults, it can rarely occur in children. Since it is not a very common disease and its symptoms can be confused with other conditions, patients must describe their symptoms clearly to their doctor. Many individuals mistakenly confuse achalasia with gastroesophageal reflux disease (GERD) because both conditions involve regurgitation of swallowed food. However, while GERD is caused by stomach contents flowing back into the esophagus, achalasia results from the difficulty of food passing from the esophagus into the stomach.
What Are the Symptoms of Achalasia?
The most common symptom of achalasia is difficulty swallowing (dysphagia). Many patients report a sensation of food getting stuck in their throat or esophagus. This condition can also cause coughing and throat irritation and increases the risk of aspiration and choking.
Achalasia symptoms gradually worsen over time. Patients may initially have mild difficulty swallowing, but as the disease progresses, even solid foods become difficult to swallow. Other symptoms of achalasia include:
- Chest pain and discomfort
- Burning sensation in the chest and stomach
- Pain or discomfort after eating
- Gagging or vomiting
- Burping
- Pneumonia (in cases of aspiration)
- Coughing
- Weight loss
What Causes Achalasia?
There are various factors that may contribute to the development of achalasia, including:
- Genetics: Individuals with a family history of achalasia or other digestive disorders are at a higher risk.
- Autoimmune diseases: Autoimmune conditions can damage the nerves of the lower esophageal sphincter, leading to achalasia.
- Esophageal cancer and parasitic infections: Some infections or cancers may trigger or worsen the disease.
- Viral infections: Some researchers suggest that viral infections may contribute to the development of achalasia, although the exact cause remains unknown.
Although nerve damage is believed to be the primary cause, further scientific research is still needed to fully understand the condition.
How Is Achalasia Diagnosed?
Doctors may suspect achalasia in patients experiencing vomiting, chest pain, dysphagia, a sensation of food accumulation in the esophagus, and weight loss. Diagnosis and treatment are typically handled by gastroenterology departments in hospitals.
The key diagnostic methods for achalasia include:
- Esophageal Manometry: A thin tube is inserted into the esophagus while the patient swallows to measure the function of the lower esophageal sphincter.
- X-ray or Imaging Tests: These are used to examine the esophagus for any abnormalities.
- Endoscopy: A tube with a camera and light is inserted into the digestive tract to visually inspect the esophagus, stomach, and duodenum.
- Barium Swallow Test: The patient drinks a liquid containing barium, which is tracked via X-rays to detect blockages or abnormalities in the esophagus.
How Is Achalasia Treated?
There is no cure to restore nerve function in the lower esophageal sphincter, but several treatments can significantly reduce symptoms. Surgical procedures can also create long-term improvements.
The primary treatment methods include:
- Pneumatic (Balloon) Dilation: A balloon is inserted into the esophagus and inflated to widen the lower esophageal sphincter, allowing food to pass more easily. This method carries a risk of tearing the sphincter, which may require surgical repair.
- Esophagomyotomy (Peroral Endoscopic Myotomy – POEM): A minimally invasive surgical procedure where a small incision is made in the esophagus, and the lower sphincter muscle is cut to reduce obstruction. A potential side effect of this procedure is gastroesophageal reflux disease (GERD).
- Heller Myotomy: A laparoscopic surgery involving five small incisions, which reduces the risk of GERD using a technique called partial fundoplication.
- Botulinum Toxin (Botox) Injections: Botox is injected into the sphincter muscle to temporarily relax it. This treatment is mainly for elderly patients or those who cannot undergo surgery, but it is not a long-term solution.
- Muscle Relaxant Medications: These may be prescribed for patients who are not candidates for surgery, but they do not provide a permanent cure.
In most cases, balloon dilation is the first choice, followed by surgery if necessary. Surgical treatments have up to a 95% success rate, though some patients may require repeated procedures.
After treatment, patients must maintain a proper diet and follow their doctor’s recommendations to prevent complications.
When Should You See a Doctor?
If you suspect you have achalasia or experience difficulty swallowing, chest pain, or regurgitation, you should consult a gastroenterologist for evaluation. Early diagnosis and treatment can help prevent complications and improve quality of life.