Achalasia | Esophagus disorder | Esophageal achalasia

 

Achalasia is generally described as a rare disorder in which damaged nerves in your esophagus prevent it from working as normal. Muscles present in the end of your esophagus did not allow food to enter your stomach. Symptoms of this disorder include trouble in swallowing, heartburn and chest pain. Treatment for this disorder includes both nonsurgical options like Botox injections, balloon dilation, medicines and other surgical options.

Usually, Achalasia happens when nerves in the esophagus become damaged in your body. Because of this disorder, the esophagus in your body suddenly become paralyzed and dilated over the period of time which eventually loses its ability to swallow food and enter into the stomach.Ins ome rare cases, the food is collected in the esophagus part, it ferments the food and is washed back up into the mouth but it tastes bitter. Some of the people with this illness mistake this as gastroesophageal reflux disease (GERD). 

There is no cure for this achalasia disorder. If the esophagus is paralyzed, then muscles in this part cannot work properly again. But symptoms can be managed with help of endoscopy, minimally invasive therapy or surgery.

Causes

There is no exact cause of failing of esophageal muscles and relaxing normally is unknown. Some of them say that achalasia is an autoimmune disease which can be triggered by a virus. Because your immune system attacks the nerve cells in the muscles of your esophagus and at the LES. Your nerve cells which can be the control  of your muscle function, but it slows down for some reasons that are not clearly understood. This can lead to excessive contractions in the LES.

Symptoms

Generally, Achalasia symptoms show up gradually and worsen over the time period. Signs and symptoms may include:

• Dysphagia which means Inability to swallow and it may feel like food or drink is stuck in your throat

• Regurgitating food or saliva

• Heartburn

• Belching

• Chest pain that can comes and goes

• Coughing at night

• Pneumonia which is from aspiration of food into the lungs

• Weight loss

• Vomiting

Risk factors

Achalasia is a rare disease, so that experts do not fully understand how it occurs or why it occurs or who might have a high risk of developing this disease. 

Some of the risk factors which include:

• having a injury in your spinal cord 

• getting endoscopic sclerotherapy which helps to treat bleeding or enlarged veins

• viral infection

• autoimmune disease people

• Age especially for middle age and older adulthood

Diagnosis

Below list of test will help to diagnose achalasia:

Barium swallow:  In this test, you will swallow barium preparation which can be in liquid or other form and its movement through the esophagus which can be evaluated using  X-rays. The swallowed barium will show a narrow passage of the esophagus at the LES.

Upper endoscopy: For this test, they use a flexible, narrow tube with the camera attached on it called an endoscope  which is passed down your esophagus. The camera will capture the images of the inside of your esophagus on the screen for evaluation. This test will help you to rule out the cancerous lesions and help you to assess achalasia.

Manometry: This test will help you to measure the timing and strength of your esophageal muscle contractions and relax the lower esophageal sphincter called LES. Because of failure of LES to relax it responds to swallowing and muscle contractions along the walls of the esophagus which can be a positive test for this disorder. This test is called the “gold standard” test to diagnose achalasia.

Treatment

The main and vital goal of treating achalasia is to reduce the pressure at the lower esophageal sphincter (LES) muscle which is allowing what you eat like food and liquids to pass them easily into your stomach. Some of the therapies are:

• Injection with botulinum toxin called Botox : This will help you to relaxing the sphincter muscles. But the benefits of this injection will slow down within a few weeks or months.

• Medications and drugs like long-acting or performing nitrates or calcium channel blockers: The above stated medicines or drugs used to relax the lower esophageal sphincter. But this is not a perfect but long-term rare solution to this illness which helps to treat achalasia.

• Myotomy is Surgery:  In this method, the lower sphincter muscle called LES is cut. This method of procedure is typically performed with the help of a laparoscope.

• Widening means dilation of the esophagus: This can be done during the process of EGD by stretching the lower sphincter muscles with a balloon dilator.

Your healthcare professional will help you to decide which is the best treatment for you.

Complications of achalasia

Usually, the complications of achalasia can be the result of food backing up called regurgitating into your esophagus which is then drawn into your trachea called windpipe that can lead to your lungs.

Some complications are:

• Pneumonia

• Lung infections or pulmonary infections

Other complications are:

• Esophageal cancer. (Achalasia increases your risk of Esophageal cancer)

Frequently Asked Questions

Q1. What is the main cause of achalasia?

Ans: It is caused by loss of the nerve cells that control the swallowing muscles in the esophagus.

Q2. What is the main treatment of achalasia?

Ans: The most common surgical technique used to treat achalasia is called the Heller myotomy.

Q3. Is achalasia life threatening?

Ans: The aspiration of saliva and food contents by people with achalasia may cause pneumonia, other pulmonary infections, or even death.

Q4. Is achalasia curable?

Ans: There's no cure for achalasia. Once the esophagus is paralyzed, the muscle cannot work properly again.

Q5. Can acid reflux cause achalasia?

Ans: we believe that gastroesophageal reflux disease (GERD) might be one of the triggering factors leading to the development of achalasia.