Achalasia is a condition in which the esophagus cannot move food to the stomach. The lower esophageal sphincter, a valve at the end of the esophagus, remains closed during swallowing, resulting in food being backed up. You can find more information below.

What is achalasia?

Achalasia is a disease of the esophagus. In more detail, it is a functional disorder of the muscles of the esophagus. The disorder mainly affects the lower part of the esophagus and prevents food and drink from entering the stomach.

The esophagus is covered with a smooth muscle layer. These muscles use regular movements to ensure that swallowed food is transported through the esophagus to the stomach. In achalasia, this transport process is disrupted. The lower part of the esophagus, especially the passage to the stomach ( gastroesophageal passage ), is no longer comfortable. As a result, food can no longer be transported to the stomach, causing severe pain for many patients.

Who is affected?

Achalasia affects thousands of people around the world. It is typically diagnosed in adults, but can also occur in children in some cases. There is no particular race or ethnic group that is particularly affected and it is not genetic.

This disease affects men and women equally. The disease is most common in old age. However, in very rare cases, children and even newborn babies can also show signs of the disease.

Is it a serious disease?

For several years, people with this disease have increased difficulty eating solid food and sometimes drinks. As their condition progresses, the disease can cause significant weight loss and malnutrition.

It is worth noting that there is also a small increase in the risk of developing cancer of the esophagus (esophageal cancer) in these people, especially if the obstruction has been ongoing for a long time. Your doctor may recommend regular endoscopic screenings for the prevention and early detection of esophageal cancer.

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What causes achalasia?

The exact cause of achalasia is not yet clear. Doctors assume that the disease is caused by a defect in nerve cells that control the muscles of the esophagus in healthy people . Due to the reduction of nerve cells, some signaling molecules (neurotransmitters) are missing.

The muscles of the esophagus can still contract, but the lack of nerve cells and messenger substances makes it difficult for the muscles to relax. This leads to an almost permanent contraction, especially in the lower parts of the esophagus. The passage from the esophagus to the stomach is particularly important for the development of symptoms.

There is normally a type of sphincter that prevents food particles and stomach acid from re-entering the esophagus . This muscle opens to allow food to pass from the esophagus to the stomach in healthy people.

In achalasia, this mechanism is disturbed by the high tension of the muscles. The sphincter is significantly more difficult to open. The buildup of food that cannot overcome the sphincter creates high pressure in the esophagus. This pressure stretches them and sometimes causes severe pain.

What are the symptoms of achalasia disease?

Not everyone with the disease will have symptoms. But most people have trouble swallowing food or drink ( known as dysphagia ). Swallowing tends to become increasingly difficult or painful, sometimes to the point where it is impossible over the years.

Other symptoms include:

  • removing undigested food
  • Choking and coughing while sleeping
  • heartburn
  • chest pain
  • repeated chest infections
  • vomit or saliva
  • Gradual but significant weight loss

Achalasia symptoms can begin at any time in life. A long-term untreated illness only slightly increases the risk of developing esophageal cancer.

This means it’s important that you get the appropriate treatment for achalasia right away, even if your symptoms don’t bother you.

Which doctor should I go to for achalasia?

If achalasia is suspected, your family doctor may refer you to a gastroenterologist or a hepatologist for diagnosis and treatment. In some cases, you may also need to see thoracic surgery.

How is achalasia diagnosed?

The doctor examines the suspicion of achalasia on the basis of the symptoms that patients often suffer for several years. To ensure the diagnosis, extensive equipment diagnostics is also required, which consists of the following procedures:

  • Gastroscopy (endoscopy)
  • X-ray
  • Pressure measurement (manometry)
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If symptoms are unclear, the diagnosis can be expanded with cross-sectional imaging in the form of computed tomography . Necessary information about diagnostic methods is given below:

Gastroscopy (endoscopy)

The standard diagnostic procedure for achalasia is endoscopy of the esophagus. This method; shows a reflection of the esophagus, stomach, and small intestine. The main purpose of endoscopy is to rule out the presence of other diseases that can cause symptoms similar to achalasia.

These diseases include, for example, cancer of the esophagus, stomach cancer, and inflammatory changes that can cause blockage of the sphincter. Due to food residues left in the esophagus, there is usually significant inflammation in the lower part of the esophagus. It is recognized during endoscopy.

X-ray

One of the X-ray methods used to detect achalasia is the barium swallow . The patient swallows contrast material, which shows a clear color on the X-ray image. Immediately afterwards, an X-ray of the upper body and esophagus is taken. With achalasia, problems of the esophagus in the transition area to the stomach are noticed in this X-ray image and the necessary treatment is started.

Pressure measurement (manometry)

The pressure in the lower esophageal sphincter area is determined using a probe. In the case of achalasia there is increased pressure in this area. In addition, incomplete or reduced own movements of the esophagus can be determined. When the doctor collects the patient’s symptoms and the results of these examinations, he can easily diagnose the disease.

How is achalasia treated?

Various methods are available for the treatment of achalasia. Some of them are:

  • Medication
  • Pneumatic dilation (expansion of the esophagus with an inflatable balloon)
  • Botulinum toxin injection (botox injection)
  • Myotomy (surgical widening of the sphincter)

Necessary information about these is given under the following headings:

Medication

Medical treatment of achalasia is very rarely done and is only helpful in mild cases with less obvious symptoms. Medications are used to lower the pressure in the esophagus by helping to relax the esophageal muscles.

The most important drugs used in the treatment of achalasia are nitrates and calcium blockers. Your doctor will decide which medicine to take and how.

pneumatic dilation

Pneumatic dilation is the most important component in the treatment of achalasia and is currently the first-choice treatment. During the endoscopic examination, an inflatable balloon catheter is inserted into the esophagus and positioned in the lower sphincter region. This balloon is then inflated and widens the very narrow esophagus.

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This treatment is successful in 85 percent of cases. Five years after pneumatic dilatation, approximately 40-75 percent of patients continue their lives without any problems.

botox injection

Botulinum toxin , also known as botox, is an active ingredient that prevents muscles from contracting. In the treatment of achalasia, Botox is injected into the lower esophageal sphincter. As a result, the muscle can no longer contract, resulting in relaxation.

In many cases, this type of treatment can normalize the pressure in the esophagus and thus successfully treat the symptoms. However, a botox injection only takes about six to nine months. A new injection should then be given to continue symptom relief.

Myotomy

Myotomy is a surgical procedure that is also used to treat achalasia. In this procedure, part of the sphincter is cut. As a result, the muscle contracts less and the esophagus relaxes.

However, these operations are mostly reserved for difficult cases that cannot be successfully treated with pneumatic dilation. One of the most important complications that occur with this type of surgery is permanent reflux disease.

How should achalasia patients be fed?

There is no specific diet for achalasia, but you can discover on your own which foods pass more easily through your esophagus.

Drinking more water with meals may help. Sometimes carbonated drinks like cola also help. Fizzy drinks seem to help food pass through the esophagus.

If your disease is severe, a liquid diet may be the best choice for a while. If you don’t eat solid foods, you should always get your doctor’s opinion on getting the right nutrients. Even if you lose a lot of weight, you should definitely see a doctor.

Can achalasia be prevented?

Adopting simple practices during meals can help our bodies fight disease and prevent various disorders. For example, you can do the following:

  • Swallowing therapy is a simple swallowing technique applied with the help of a speech therapist who helps the patient swallow and eat better by adopting certain practices to strengthen the internal muscles.
  • Swallowing exercises can increase the tone and strength of the lower esophageal sphincter.
  • Change your diet and eating patterns and choose a softer or pureed diet that can aid in better swallowing.
  • Keep the time between your meals regular and avoid skipping meals.
  • Always moisten your throat and increase the amount of fluid in your body.

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