Achalasia

What is achalasia?

Achalasia is an abnormality in the muscles of the esophagus.
At the lower end of the esophagus, there is a ring-like muscle that controls the downward movement of the food in the esophagus. It has nerve connections.  It is also the demarcating line between the esophagus and the stomach. It ensures that the food does not return to the throat from the stomach. But in achalasia, this muscle, that can also be called a sphincter, is no longer tense enough to close up against the stomach when food is swallowed. The muscle has become weak. The esophagus leads the mouth to the stomach. When the nerves that are connected to this sphincter are bad or when the muscle itself is bad, achalasia will surface. So instead of food flowing straight to the stomach, it flows back to the throat.
More than three thousand persons are affected with achalasia every year in the US.

Causes of achalasia

Even when the problem is with the weak sphincter or its degenerated nerves, it can be quite hard sometimes for doctors to identify the actual cause. Researchers submit that it may be due to an autoimmune attack of the cells of the body. It has also been attributed to genetic factors.
Chagas’s, disease and cancer of the esophagus can mimic achalasia and its symptoms.

Risk factors for achalasia

All age groups are liable to be affected with achalasia but people in their mid-age and older adults are more liable. People with autoimmune diseases are also at risk.

Symptoms of achalasia

Achalasia patients have dysphagia as the number one symptom amongst many others. In dysphagia, they usually experience difficulty in swallowing anything they feed on. They have this feeling of food being stuck in their throat. They get chocked with their food. This can initiate cough and aspiration.
Achalasia patients will also experience weight loss, painful chest, heartburn and post-feeding pains.
They could also have regurgitation, a symptom of acid reflux.

Diagnosis of achalasia

Your doctor will sense that you have achalasia when you report having difficulty swallowing any meal – whether liquid, semi-solid or solid more so if it worsens with time.
Esophageal manometry will be used by your doctor to eventually diagnose achalasia. A tube will be inserted through your mouth into your esophagus. You will now be asked to swallow something. As you swallow, the tube will be recording the activity of the muscle in your lower esophagus. From the recordings, he can now know whether the muscle is working well.
An X-ray can also be used to view the muscles of your lower esophagus for the purpose of diagnosis. An endoscopy could as well be carried out on you. In endoscopy, a camera attached to a tube is used to view your esophagus.
There is yet another diagnostic approach to achalasia – barium swallow. From the name, you can deduce that you will be required to swallow liquid barium. As you are swallowing it, the doctor will be observing its movement in the esophagus via X-rays.

Treatment for achalasia

Most achalasia treatments target the sphincter separating the esophagus from the stomach.
There are two approaches to this – pneumatic dilation and esophagostomy.

Pneumatic dilation

It appears to be the first line of treatment to relieve symptoms. The sphincter is dilated with the aid of a special type of balloon. The balloon will first be inserted into your esophagus and then inflated. As the balloon inflates, the sphincter expands. The expanded sphincter can then let food content flow easily through it. Overinflation of the balloon can cause a tear that might require a repair to the sphincter.

Esophagomyotomy

It is a surgical procedure used to ‘clear’ the ring of muscle in the lower part of the esophagus. This is to allow for easy passage of food content down to the stomach. To do this, an incision will be made in the muscle and it will gradually be widened by chopping off the tissues little by little until it is wide enough to allow for food passage. Huge successes have been recorded from this approach. The only risk that you might have is acid reflux from the stomach into the esophagus which could make your heart experience a burning sensation from the acid.
In situations where you are not able to undergo a correction by surgery or pneumatic approach, Botox injection might be used by your doctor to bring about the relaxation of the sphincter. It will be injected directly into the sphincter by an endoscope.
In instances where these alternatives are not readily available or do not work out, calcium or nitrates channel blockers can be quite useful in helping the sphincter to relax for food to transit through it easily.

Long-term outlook

To treat achalasia successfully, multiple approaches might be adopted. The symptoms roam between two degrees – mild and severe and their outlook thus differs.
If a pneumatic dilation fails, the doctor will then do surgery. Oftentimes, the tint of success reduces with each step of dilation. The more reason your doctor will likely switch to other alternatives if numerous dilations are unfruitful.
Give or take, 95 percent success has been reported with the surgical approach to achalasia’s treatment although not without a few complications. Backflow of food into the trachea, acid reflux, and esophageal tears were some of such complications recorded. Symptoms’ relief was perfect, notwithstanding.

The Network Nurse

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