Achalasia

Definition

Achalasia is a disorder of the esophagus (the tube that carries food from the mouth to the stomach). The esophagus is less able to move food toward the stomach, and the muscle from the esophagus to the stomach does not relax as much as it needs to during swallowing. This relaxation is needed to allow food to enter the stomach.

Alternative Names

Causes

The main abnormality in achalasia is a failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing. The disorder is characterized by loss of the wave-like contraction of smooth muscles that forces food through the digestive tract. (These contractions are called peristalsis.)

Another part of the disorder is lack of nervous stimulation to the esophagus. Causes include damage to the nerves to the esophagus, parasitic infection, cancers, and hereditary factors. Achalasia is a rare disorder, may occur at any age, but is most common in middle-aged or older adults.

Symptoms

• Difficulty swallowing liquids and solids
• Regurgitation (backflow) of food
• Chest pain which may increase after eating or may radiate to the back, neck, and arms
• Unintentional weight loss
• Heartburn
• Cough

Exams and Tests

An upper GI x-ray test or barium esophagogram may show absence of peristalsis, an enlarged esophagus, and a narrowing at the bottom of the esophagus. The diagnosis is confirmed with esophageal manometry. Physical examination may show signs of anemia.

Treatment

The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter with special instruments.

Therapy usually involves widening of the lower sphincter or injection with botulinum toxin (Botox) to paralyze it and prevent spasms. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter.

Surgery (called an esophagomyotomy) to decrease the pressure in the lower sphincter may be needed. Your doctor can help you decide which treatment is best for your situation.

Outlook (Prognosis)

The outcomes of surgery and dilation are similar. Sometimes more than one dilation is necessary.

Possible Complications

• Tearing (perforation) of the esophagus
• Regurgitation of acid or food from the stomach into the esophagus (reflux)
• Aspiration of food contents into the lung that can cause pneumonia

When to Contact a Medical Professional

Call your provider if you have persistent difficulty swallowing or painful swallowing, or if symptoms persist despite treatment for achalasia.

Prevention

Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.