Achalasia is a rare esophageal disorder in which the esophagus has trouble transporting food to the stomach. Since sluggish digestive motion is involved in achalasia, it is known as a motility disorder of the gastrointestinal tract. The lower esophageal sphincter, which is a ring around the site where the esophagus and stomach join, is supposed to relax when swallowing, but In patients with achalasia it does not function properly.
Causes of Achalasia
Achalasia is typically caused by damage to the esophageal nerves. Sometimes, it may be an hereditary condition. Achalasia occurs most frequently in middle-aged or older adults.
Symptoms of Achalasia
The symptoms of achalasia are very uncomfortable and interfere with everyday life. They may include:
- Unintentional weight loss
- Regurgitation
- Chest pain, particularly after eating, which may extend to the back, neck, and arms
- Cough
- Difficulty swallowing
- Heartburn
- Anemia
Diagnosis of Achalasia
In addition to a thorough physical examination, the doctor may perform the following diagnostic tests for achalasia:
- Blood tests
- Upper endoscopy
- X-rays of the upper GI tract
- Esophageal manometry
Treatment of Achalasia
Treatment of achalasia is designed to reduce the pressure at the lower esophageal sphincter. It may involve:
Injection of BOTOX®
One treatment for achalasia is the injection of BOTOX, or botulinum toxin, into the esophageal sphincter during endoscopic surgery. BOTOX will weaken the sphincter muscles sufficiently to enable food to once again move from the esophagus to the stomach without a problem. Although this treatment is usually successful, it is not long-lasting and must be repeated periodically -- from every few weeks to every few months. BOTOX injections are most frequently used in elderly patients or patients at high risk for post-surgical complications.
Medications
Calcium channel blockers or long-acting nitrates may also be used as a treatment for achalasia since they relax the lower esophagus sphincter. They are often especially effective when symptoms first appear. For most patients, however, medications are only likely to provide short-term relief and for many patients medications may have troubling side effects.
Surgery
Two types of surgery may be considered to remedy achalasia: cutting the muscle of the sphincter, also known as esophagomyotomy or Heller myotomy, or dilatation of the esophagus where it is most narrow during an endoscopy, known as esophagogastroduodenoscopy.
Risks of Achalasia
The treatments for achalasia are quite safe, but when surgical procedures are undertaken there are always risks. In general, the risks of surgery may include:
- Excessive bleeding
- Blood clots
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
The surgical procedures used to treat achalasia may further include the following complications::
- Regurgitation of acid or food, known as reflux
- Aspiration pneumonia caused by breathing food into the lungs
- Perforation or tearing of the esophagus
Recovery from Achalasia
Recovery from the surgical procedure performed to treat achalasia varies depending on whether the surgery is performed as open surgery or laparoscopically. Since the laparoscopic procedures are minimally invasive and require smaller incisions, they result in less pain and a more rapid recovery.
