There is a rare condition called achalasia that affects the esophagus, which connects your mouth to your stomach. This condition makes it difficult for food and liquid to pass from your throat to your stomach. This blog post describes what causes achalasia, what the symptoms are, how it is diagnosed, how to treat, and how it can be prevented.
The exact cause of achalasia is not known, but researchers believe it may be related to a combination of factors, such as:
Genetics. Some people may inherit a tendency to develop achalasia from their family members.
Autoimmune disease. This is when your immune system mistakenly attacks your own healthy cells. Achalasia may be caused by an autoimmune reaction that damages the nerves in your esophagus.
Viral infection. Some viruses may trigger an autoimmune response or directly infect the nerves in your esophagus.
Chagas disease. This is a rare parasitic infection that mainly affects people in Latin America. It may increase the risk of developing achalasia.
People with achalasia usually experience difficulty swallowing (dysphagia), which may feel like food or drink is stuck in their throat. They may also have other symptoms, such as:
Regurgitation. This is when food or saliva comes back up into the mouth from the esophagus.
Heartburn. This is a burning sensation in the chest caused by acid reflux from the stomach.
Belching. This is when air comes out of the mouth during swallowing.
Chest pain. This may occur when food or acid irritates the esophagus or when there is inflammation or infection in the esophagus.
Coughing at night. This may happen when food or acid enters the lungs (aspiration) during sleep.
Pneumonia. This is an infection of the lungs caused by bacteria or viruses that enter through aspiration.
Weight loss. This may result from poor nutrition due to difficulty swallowing or vomiting.
Vomiting. This may occur when food or acid irritates the stomach or when there is inflammation or infection in the stomach.
To diagnose achalasia, your doctor will ask you about your symptoms and medical history, examine your throat and chest with a stethoscope and a lighted instrument called an endoscope, and perform some tests to check how well your esophagus works.
Some of these tests are:
Esophageal manometry. This measures how well your esophagus contracts and relaxes during swallowing.
Barium swallow. This involves drinking a liquid containing barium that coats and fills your esophagus on an X-ray image.
Endoscopy. This involves inserting a thin tube with a camera into your mouth and down to your esophagus to look for any abnormalities.
Biopsy. This involves taking a small sample of tissue from your lower esophageal sphincter (LES), which is where food enters your stomach.
The severity of the condition and the preferences of the patient determine the type of treatment for achalasia. A number of these treatments are nonsurgical, meaning they do not involve cutting or removing any part of the esophagus. In order to repair the esophagus, an incision is made in the abdomen or chest.
Nonsurgical treatments for achalasia include:
Through a thin tube, a balloon is inserted into the lower esophageal sphincter (LES), which controls the opening between the esophagus and stomach. Food and liquids will be able to pass more easily into the stomach if the balloon is inflated to stretch and widen the LES. This procedure may need to be repeated several times over time.
A small amount of botulinum toxin type A (Botox) is injected directly into the LES through an endoscope, which is a thin tube with a camera and light attached to it. The Botox weakens and relaxes the LES muscles. them more likely to open when swallowing. This effect may last for several months.
Nitroglycerin or nifedipine, which can be taken orally or injected, can relax or dilate the LES muscles before eating.
Surgical treatments for achalasia include:
A Heller myotomy involves making a small incision either in front or behind the LES, depending on the type of surgery performed. The lower end of the LES is cut or removed, creating a smaller opening for food and liquids to enter.
Similar to Heller myotomy, Nissen fundoplication tightens and strengthens the LES muscles, preventing acid reflux from flowing back into the esophagus.
An endoscope is used to make an incision in front of or behind the LES. The muscle at this point is removed, allowing food and liquids to enter the stomach through a larger opening.
Treatment for achalasia depends on several factors, including your age, health condition, symptoms severity, response to previous treatments, and personal preferences. Before deciding on a treatment plan, your doctor will discuss with you the benefits and risks of each option.
There is no known way to prevent achalasia, as the exact cause is still unclear.
However, you can take some steps to reduce your risk of complications and improve your quality of life, such as:
Eating slowly and chewing well. This can help you swallow more easily and avoid choking or regurgitation.
Drinking plenty of fluids. This can help you wash down food and prevent dehydration.
Avoiding foods that trigger symptoms. This may include spicy, acidic, or carbonated foods and drinks that may cause heartburn or irritation.
Elevating your head when sleeping. This can help prevent acid reflux and aspiration at night.
Seeking medical attention promptly. If you notice any signs of achalasia, such as difficulty swallowing, chest pain, or weight loss, you should see your doctor as soon as possible. Early diagnosis and treatment can prevent further damage to your esophagus and improve your prognosis.
