About achalasia

What is achalasia?

Achalasia is a rare disease of the muscle of the esophagus (swallowing tube). The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, patients with achalasia have difficulty in swallowing food.

How does the normal esophagus function?

The esophagus has three functional parts. The uppermost part is the upper esophageal sphincter, a specialized ring of muscle that forms the upper end of the tubular esophagus and separates the esophagus from the throat. The upper sphincter remains closed most of the time to prevent food in the main part of the esophagus from backing up into the throat. The main part of the esophagus is referred to as the body of the esophagus, a long, muscular tube approximately 20 cm (8 in) in length. The third functional part of the esophagus is the lower esophageal sphincter, a ring of specialized esophageal muscle at the junction of the esophagus with the stomach. Like the upper sphincter, the lower sphincter remains closed most of the time to prevent food and acid from backing up into the body of the esophagus from the stomach.

The upper sphincter relaxes with swallowing to allow food and saliva to pass from the throat into the esophageal body. The muscle in the upper esophagus just below the upper sphincter then contracts, squeezing food and saliva further down into the esophageal body. The ring-like contraction of the muscle progresses down the body of the esophagus, propelling the food and saliva towards the stomach. (The progression of the muscular contraction through the esophageal body is referred to as a peristaltic wave.). By the time the peristaltic wave reaches the lower sphincter, the sphincter has opened, and the food passes into the stomach.

How is esophageal function abnormal in achalasia?

In achalasia there is an inability of the lower sphincter to relax and open to let food pass into the stomach. In at least half of the patients, the lower sphincter resting pressure (the pressure in the lower sphincter when the patient is not swallowing) also is abnormally high. In addition to the abnormalities of the lower sphincter, the muscle of the lower half to two-thirds of the body of the esophagus does not contract normally, that is, peristaltic waves do not occur, and, therefore, food and saliva are not propelled down the esophagus and into the stomach. A few patients with achalasia have high-pressure waves in the lower esophageal body following swallows, but these high-pressure waves are not effective in pushing food into the stomach. These patients are referred to as having "vigorous" achalasia. These abnormalities of the lower sphincter and esophageal body are responsible for food sticking in the esophagus.

What are the symptoms for achalasia?

People with achalasia typically experience dysphagia, or trouble swallowing and feeling as if food is stuck in their esophagus. Dysphagia can cause coughing and raise your risk of inhaling and choking on food.

Other possible symptoms include:

  • pain or discomfort in your chest
  • unexplained Weight loss
  • Heartburn
  • intense pain or discomfort after eating
  • dry mouth
  • dry eyes

You might also have regurgitation or backflow. These symptoms can happen with other gastrointestinal conditions, such as acid reflux. In fact, people with achalasia sometimes first get an incorrect diagnosis of gastroesophageal reflux disease (GERD).

What are the causes for achalasia?

The follow list shows some of the possible medical causes of Achalasia that are listed by the Diseases Database: Esophageal achalasia

What are the treatments for achalasia?

In achalasia there is an inability of the lower sphincter to relax and open to let food pass into the stomach. In at least half of the patients, the lower sphincter resting pressure (the pressure in the lower sphincter when the patient is not swallowing) also is abnormally high. In addition to the abnormalities of the lower sphincter, the muscle of the lower half to two-thirds of the body of the esophagus does not contract normally, that is, peristaltic waves do not occur, and, therefore, food and saliva are not propelled down the esophagus and into the stomach. A few patients with achalasia have high-pressure waves in the lower esophageal body following swallows, but these high-pressure waves are not effective in pushing food into the stomach. These patients are referred to as having "vigorous" achalasia. These abnormalities of the lower sphincter and esophageal body are responsible for food sticking in the esophagus.

What are the risk factors for achalasia?

Because of achalasia’s rarity, experts don’t fully understand how or why it occurs, or who might have a greater risk of developing the condition.

A few potential risk factors include:

  • having a spinal cord injury
  • getting endoscopic sclerotherapy to treat bleeding or enlarged veins
  • having a viral infection
  • having an autoimmune disease
  • age — it’s more common in middle age and older adulthood

Future research on achalasia may help experts learn more about possible factors contributing to its development, along with strategies that might help prevent the condition.

Is there a cure/medications for achalasia?

Esophageal achalasia is noted to be an idiopathic motility disorder. It is featured by incomplete relaxation of the LES (lower esophageal sphincter) in response to swallowing, as well as peristalsis in the esophagus. This is likely to trigger impaired food bolus transport.

  • Dysphagia is evident to be the most common symptom in patients suffering from achalasia.
  • Other symptoms include chest pain, regurgitation, weight loss, heartburn, nocturnal coughing, and postprandial aspiration.
  • To date, there is no cure for achalasia. The symptoms can be managed if diagnosed early.
  • However, an effective form of treatment can be myotomy which is performed surgically or endoscopically. Endoscopic myotomy is performed via peroral endoscopic myotomy (POEM) or pneumatic balloon dilation.
  • Surgical myotomy involves the laparoscopic Heller myotomy.
  • It is usually associated with fundoplication to reduce the risk of severe symptomatic GERD (gastroesophageal reflux disease).
  • BT (Botulinum toxin) injection is the most effective pharmacological therapy utilized for treating achalasia. It is prescribed to elderly patients, individuals with multiple comorbidities, salvage therapy, and patients vulnerable to surgeries.

The ongoing research on BT and achalasia may generate an efficient role of BT injection as a cost-effective, minimally invasive, and effective form of therapy for individuals with achalasia.

Conditions
Issues with the immune system,Having Chagas disease,Herpes or other viral infection,Bacterial disease,Stress
Drugs
BT injection, muscle relaxants such as nifedipine or nitro-glycerine
Symptoms
Dysphagia,Regurgitating food or saliva,Heartburn,Belching,Chest pain,Coughing at night,Pneumonia,Weight loss,Vomiting

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