Achalasia is a disorder of the esophagus in which the nerve cells and muscles do not work properly. This can lead to difficulties with swallowing, chest pain, regurgitation, and coughing and breathing problems, if food gets into the lungs.
Esophageal achalasia is an esophageal motility disorder. Achalasia can affect any part of the digestive tract, including the intestines. Hirschsprung’s disease is a type of achalasia.
Patients usually receive a diagnosis between the ages of 25 years and 60 years. It affects around 1 in every 100,000 people. It appears equally in men and women,
The cause is unknown and there is no cure, but treatment can bring relief.
What is esophageal achalasia?
In achalasia, food does not get pushed down into the stomach.
The esophagus, or gullet, is the tube that connects the throat, or pharynx, with the stomach. It is located between the windpipe, or trachea, and the spine. It goes down the neck and joins the upper, or cardiac, end of the stomach.
An adult esophagus is approximately 10 inches, or 25 centimeters, long.
When we swallow, the muscles within the esophagus walls contract and push the food or liquid down into the stomach. Glands within the esophagus produce mucus, and this helps us to swallow.
In esophageal achalasia, the esophagus does not open to let food pass through, because there is a weakness in the smooth muscle of lower part of the esophagus, and the lower esophageal sphincter. The inability of the smooth muscle inside the esophagus to move food down is known as aperistalsis of the esophagus.
Achalasia is a chronic disease in which the nerve function deteriorates over time.
The cause remains unknown, but according to Society of Thoracic Surgeons, recent studies suggest it may be an autoimmune disease. In this kind of disease, a person’s immune system mistakenly attacks healthy cells in the nervous system of the esophagus. A parasite in South America that leads to Chagas disease can also cause it.
It does not run in families.
At first, symptoms may be minor and easy to ignore, but eventually, it becomes harder to swallow food and liquid.
The person may notice:
Dysphagia, or difficulty in swallowing food
Regurgitation of indigested food, and later, liquid
Coughing, especially when lying down
Chest pain, similar to heartburn, which can be confused with a heart attack
Aspiration, when food, liquid, and saliva are inhaled into the lungs
The person may also lose weight, have difficulty burping and feel as if they have a lump in their throat.
Symptoms are usually mild and ignored at first, and people may try to compensate by eating more slowly or by lifting the neck or throwing the shoulders back to help them swallow.
However, symptoms typically get progressively worse.
Achalasia symptoms are similar to those of gastroesophageal reflux disease (GERD), hiatus hernia, and some psychosomatic disorders. This can make diagnosis harder.
The doctor may order the following diagnostic tests:
X-ray and barium swallow test: The patient swallows a white liquid solution, known as barium sulfate. Barium sulfate is visible to x-rays. As the patient swallows the suspension, the esophagus becomes coated with a thin layer of barium, enabling the hollow structure to be imaged.
Esophageal manometry: This measures muscle pressure and movements in the esophagus. A pressuring device called a monometer is used. A thin tube goes through the patient’s nose, and they have to swallow several times.
The device measures muscle contractions in various parts of the esophagus. This procedure helps the doctor determine whether the lower esophageal sphincter is relaxing properly while the patient swallows. It can also tell how well the smooth muscle is working. It can also rule out cancer.