Achalasia
Quick Facts
- Common names: Esophageal achalasia, Cardiospasm, Esophageal aperistalsis
- Affected population: Adults aged 30-60, affects 1 in 100,000 people annually
- Key symptoms: Difficulty swallowing, chest pain, regurgitation, weight loss
- Treatment approach: Pneumatic dilation, surgery (myotomy), botulinum toxin injections
What is Achalasia?
Achalasia is a rare disorder of the esophagus that makes it difficult for food and liquid to pass into the stomach. This condition occurs when nerves in the esophagus become damaged, causing the lower esophageal sphincter (LES) to fail to relax properly during swallowing. Additionally, the normal wave-like muscle contractions (peristalsis) that move food through the esophagus are absent or abnormal.
Common Symptoms
Based on patient reports, the most frequently experienced symptoms include:
Progressive difficulty swallowing both solids and liquids (dysphagia)
Feeling of pressure or tightness in the chest area
Pain that may worsen after eating or during stress
Sensation of constriction or food stuck in throat
Often nocturnal, may be due to regurgitation
Additional Symptoms
- Regurgitation: Undigested food coming back up, especially when lying down
- Weight loss: Due to difficulty eating and fear of symptoms
- Heartburn: Though less common than with GERD
- Hiccups: Persistent or frequent hiccups
- Nocturnal symptoms: Coughing, choking, or aspiration at night
Types of Achalasia
Type I (Classic)
Minimal esophageal pressurization with swallowing. The esophagus fails to contract normally, with no significant pressure buildup.
Type II (With Compression)
Pan-esophageal pressurization with at least 20% of swallows. The entire esophagus pressurizes uniformly during swallowing attempts.
Type III (Spastic)
Premature or spastic contractions with at least 20% of swallows. Characterized by abnormal, vigorous contractions in the esophageal body.
Causes and Risk Factors
The exact cause of achalasia is unknown, but several factors may contribute:
- Autoimmune response: Antibodies attacking nerve cells in the esophagus
- Viral infections: Possible trigger for autoimmune response
- Genetic factors: Rare familial cases have been reported
- Neurodegenerative process: Loss of neurons in the myenteric plexus
- Secondary causes: Chagas disease (in endemic areas), certain cancers
Diagnosis
Accurate diagnosis requires several tests:
- Esophageal manometry: Gold standard test measuring pressure and muscle contractions
- Barium swallow X-ray: Shows characteristic "bird's beak" appearance of narrowed LES
- Upper endoscopy: Rules out cancer and assesses esophageal lining
- High-resolution manometry: Provides detailed pressure mapping and subtype classification
- Timed barium esophagram: Assesses esophageal emptying over time
Treatment Options
Non-Surgical Treatments
- Pneumatic dilation: Balloon stretching of the LES under sedation
- Botulinum toxin injection: Temporary paralysis of LES muscles
- Medications: Calcium channel blockers or nitrates (limited effectiveness)
- Dietary modifications: Eating slowly, drinking fluids with meals, avoiding temperature extremes
Surgical Treatments
- Laparoscopic Heller myotomy: Cutting the LES muscle fibers
- POEM (Peroral Endoscopic Myotomy): Endoscopic muscle cutting through the mouth
- Fundoplication: Often added to myotomy to prevent reflux
- Esophagectomy: Rarely needed for end-stage disease
Management Strategies
- Eating habits: Eat slowly, chew thoroughly, remain upright after meals
- Food consistency: Start with liquids and soft foods if solids are difficult
- Temperature: Room temperature foods may be easier to swallow
- Elevate head: Sleep with head elevated to prevent nighttime regurgitation
- Stress management: Stress can worsen symptoms
- Regular follow-up: Monitor for complications and treatment effectiveness
Complications
Potential complications if untreated:
- Aspiration pneumonia from regurgitated food
- Esophageal perforation (rare)
- Megaesophagus (severe dilation)
- Increased risk of esophageal cancer (small but significant)
- Malnutrition and weight loss
Prognosis
With appropriate treatment, most people with achalasia can achieve good symptom control:
- Treatment success: 90% improvement with myotomy or POEM
- Pneumatic dilation: 70-90% initial success, may need repeating
- Long-term outlook: Most patients maintain good swallowing function
- Quality of life: Significantly improved with treatment
- Surveillance: Regular monitoring for cancer risk recommended
When to Seek Medical Help
Consult a healthcare provider if experiencing:
- Progressive difficulty swallowing
- Unexplained weight loss
- Chest pain during or after eating
- Frequent regurgitation
- Nighttime coughing or choking
- Food feeling stuck in chest or throat
Disclaimer: This information is for educational purposes only and should not replace professional medical advice. Always consult with a healthcare provider for diagnosis and treatment of medical conditions.