Achalasia is a rare disorder that makes it difficult for food and liquid to pass into your stomach. Achalasia occurs when nerves in the tube connecting your mouth and stomach (esophagus) become damaged. As a result, the esophagus loses the ability to squeeze food down, and the muscular valve between the esophagus and stomach (lower esophageal sphincter) doesn’t fully relax — making it difficult for food to pass into your stomach.
There’s no cure for achalasia. But symptoms can usually be managed with minimally invasive therapy or surgery (source).
Causes
The exact cause of achalasia is poorly understood. Researchers suspect it may be caused by a loss of nerve cells in the esophagus. There are theories about what causes this, but viral infection or autoimmune responses have been suspected. Very rarely, achalasia may be caused by an inherited genetic disorder or infection.
Symptoms
Achalasia symptoms generally appear gradually and worsen over time. Signs and symptoms may include:
- Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat
- Regurgitating food or saliva
- Heartburn
- Belching
- Chest pain that comes and goes
- Coughing at night
- Pneumonia (from aspiration of food into the lungs)
- Weight loss
- Vomiting
Diagnosis
X-ray examination (radiology) is frequently useful in the diagnosis of achalasia. Radiological examination, especially with the use of barium, may show enlargement (dilation) of the esophagus and the retention of food and secretions within the esophagus. Devices that measure fluid pressure (manometers) within the esophagus are used to confirm the diagnosis of achalasia.
Standard Therapies
Treatment
The treatment of achalasia is aimed at removing obstructions caused by the failure of the lower esophageal sphincter muscle to relax. This may be done with the administration of drugs, expanding the cross-section (manual dilation) of the sphincter muscle, or through surgery.
The drug isosorbide, (a long-acting nitrate) or nifedipine (a calcium channel blocker) may provide some relief for people with achalasia.
Approximately 70 percent of cases of achalasia may be treated effectively by the enlargement of the lower esophageal sphincter muscle through a procedure known as pneumatic balloon dilation. In many people, repeated dilations may be necessary to obtain improvement of symptoms.
Surgical treatments of achalasia may be effective in approximately 85-90 percent of cases. During these procedures, the muscle fibers in the lower esophageal sphincter are cut (laparoscopic Heller myotomy or peroral endoscopic myotomy). About 15 percent of people with achalasia experience the symptoms of gastroesophageal reflux after this surgical procedure.
