Achalasia

Achalasia is a rare disorder affecting the esophagus, characterized by the inability of the lower esophageal sphincter (LES) to relax properly, leading to difficulty in swallowing. Here’s a closer look at achalasia:

Causes

The exact cause of achalasia is not fully understood, but it is believed to involve:

  • Degeneration of Nerve Cells: Specifically, the loss of ganglion cells in the esophageal wall, which disrupts the normal muscle contractions needed for swallowing.
  • Autoimmune Response: Some theories suggest an autoimmune component may contribute to nerve damage.
  • Genetic Factors: There may be a hereditary predisposition in some cases.

Symptoms

Common symptoms include:

  • Dysphagia: Difficulty swallowing solids and liquids.
  • Regurgitation: Undigested food can come back up, sometimes leading to aspiration.
  • Chest Pain: Discomfort or pain in the chest, often mistaken for heart-related issues.
  • Weight Loss: Due to difficulty eating.
  • Heartburn: Although not common, some patients may experience reflux-like symptoms.

Diagnosis

Diagnosis typically involves:

  • Esophageal Manometry: Measures the pressure and pattern of contractions in the esophagus.
  • Barium Swallow Study: A radiologic exam where the patient swallows barium to visualize the esophagus and its movement.
  • Endoscopy: To visually inspect the esophagus and rule out other conditions.

Treatment

Treatment options aim to relieve symptoms and improve swallowing:

  • Medications: Some may benefit from medications that help relax the LES, such as nitrates or calcium channel blockers, although they are not always effective.
  • Botulinum Toxin (Botox) Injections: These can temporarily paralyze the LES, improving symptoms for some patients.
  • Dilation: A procedure where a balloon is inserted and inflated to stretch the LES.
  • Surgery: The most definitive treatment is surgical myotomy, where the muscle at the lower end of the esophagus is cut to allow for easier passage of food. This may be done laparoscopically.

Lifestyle Changes

Patients are often advised to:

  • Eat smaller, more frequent meals.
  • Avoid very hot or cold foods.
  • Stay upright for a period after eating.