Achalasia: Know the Causes, Symptoms, and Treatment
Achalasia is a rare health disorder in which the esophagus's nerves are damaged and cannot function properly resulting in failure to relax the lower esophageal sphincter eventually causing dilation of the esophagus. Let's understand achalasia, including its causes, symptoms and treatment!
Understanding achalasia: What is achalasia?
Achalasia is a rare disorder that affects the esophagus, in which food passes through the throat to the stomach. Achalasia occurs when the lower esophageal sphincter (LES) fails to open during swallowing. This muscle ring help prevent reflux of acidic gastric contents enter into esophagus, but it opens when food is eaten, allowing food to pass through.
This condition's symptoms commonly occur gradually and may worsen over time. Eventually, ingesting fluids or food may become difficult, and treatment may be needed.
Is achalasia serious?
Yes, achalasia can be severe, especially if left untreated. People with achalasia will gradually have more difficulty eating solid foods and drinking liquids, and it results in major weight loss and malnutrition. Achalasia patients also have a slightly elevated risk of developing esophageal cancer, especially if the condition has been present for a long time. The doctor may advise patients to have regular esophageal tests to detect cancer early if it does develop.
What are the symptoms of achalasia?
Achalasia symptoms appear slowly and might last for months or years. Among them are the following:
- Dysphagia (trouble swallowing if food is stuck in the esophagus)
- Weight loss
- Coughing at night
- Chest pain that comes and goes
- Regurgitation of the undigested food
Now the question is; What are the causes of achalasia?
The specific cause of achalasia is unknown. Researchers believe it could be due to several factors, including:
- Family history or genetics
- An autoimmune disorder in which the body's immune system assaults healthy cells. Damage to the esophageal nerves or LES (lower esophageal sphincter)
- Some experts believe that viral infections can trigger autoimmune responses, especially in persons who are prone to the disorder genetically.
Tests for diagnosis of Achalasia
- Upper GI endoscopy.
- Barium swallow
- Esophageal manometry.
Managing Achalasia: How is achalasia treated?
Achalasia treatment cannot completely cure the condition, although it can help to:
- Improve the ability to swallow by opening the lower esophageal sphincter (LES)
- Reduce other symptoms like pain and regurgitation
- Lower the chances of having an abnormally enlarged esophagus
The possible treatment options are:
Surgery is the most effective treatment option for achalasia because it provides long-term relief from symptoms in most patients. The Heller cardio myotomy is the most commonly performed surgical procedure.
Heller cardio myotomy
In this, the muscle is severed by the surgeon, allowing food to move easily into the stomach. When performed non-invasively, the operation is known as laparoscopic Heller cardio myotomy. Some people with Heller myotomy can develop GERD (gastroesophageal reflux disease) later in life.
Peroral endoscopic myotomy (POEM)
During POEM surgery, a surgeon inserts an endoscope into the mouth and down to the throat, creating an incision in the internal lining of the esophagus.
Non-surgical alternatives include:
During an endoscopy, the doctor injects Botox (botulinum toxin) into the constricted esophageal muscles. It temporarily relaxes the muscles, allowing people to swallow normally, but patients may require multiple settings of treatment , and problems tend to recur.
A balloon is inserted into the center of the esophageal sphincter and dilated to allow food to flow. It is performed as an outpatient operation. However, it is important to remember that if the esophageal sphincter does not remain open, the patient must undergo pneumatic dilation treatment again. About 30% of persons treated with balloon dilation within five years require repeat treatment.
Before eating, the doctor may advise you to take muscle relaxants like nitroglycerin or nifedipine. Because these medications have negative effects, they are normally reserved for patients who are unsuitable for pneumatic dilation or surgery, and Botox has not been helpful.
90% of people find a long-term improvement in symptoms after achalasia treatment. People should get a diagnosis as soon as possible so that they can begin treatment to alleviate their symptoms before the condition worsens. Achalasia patients may require many treatments before their symptoms improve. It's important to remember that if one treatment doesn't work, there may be others to consider.