Achalasia

Achalasia is a disease of the muscles of the esophagus (the tube where we swallow). It leads to patients experiencing difficulty when swallowing food. This is due to the fact that the lower sphincter of the esophagus does not relax to let food through.

What Causes Achalasia?

The cause of achalasia is unknown. It is an extremely rare condition which is believed to be down to heredity, infection or abnormalities of the immune system. When it does occur there will be degeneration of the muscles of the esophagus as well as the nerves that control the muscles in the area. The nerves will degenerate and ultimately disappear, after which the muscles will degenerate. This is what leads to the inability of the esophagus to relax and let food through.

Diagnosis and Treatment of Achalasia

Symptoms of achalasia will most notably be a difficult swallowing, chest pains and regurgitation of foods or liquid. The diagnosis of achalasia will often be based on a patient’s history where their symptoms will have become progressively worse over time. Diagnosis will usually be confirmed using an X-Ray of the esophagus, or by using a flexible fiberoptic tube known as an endoscopy.

Achalasia is best treated when diagnosed early, before the esophagus becomes dilated. However, diagnosis is often delayed since patients will compensate by chewing more carefully and taking smaller chunks of food.

Treatments for achalasia will include oral medication, dilation or stretching of the specific area of the esophagus, or an injection of Botox. These treatments work by reducing the pressure within the sphincter allowing food to pass more easily. Generally medication is not sufficient and most patients have their esophagus stretched by swallowing a tube with a balloon at the end. The main risk is rupture of the esophagus which occurs in 5% of cases of forced dilation.