Achalasia is the inability to swallow caused
by the inability of the lower esophagus sphincter
or LES to open.
Symptoms of Achalasia
The symptoms of achalasia are:
- Difficulty in swallowing
- Regurgitation of saliva or food, sometimes involuntarily
- Choking, sometimes at night during
- Bad breath
- Belching or gas
- Chest pain and heartburn, even without eating
- Weight loss and malnutrition
How is Achalasia Diagnosed?
Your doctor may do the following test to diagnose achalasia:
- Barium swallow test
Dilation, poor muscle contraction, as well as incomplete emptying
of the esophagus are seen in the barium swallow x-ray images.
This test is a visual examination of the esophagus using a flexible
tube with a camera attached.
- Esophageal manometry
This test measures the muscle contractions in the esophagus.
In achalasia, the LES loses its ability to open by relaxing its
contracted muscles. As a result, it stays closed – liquid
and food are trapped in the esophagus, sometimes causing regurgitation.
The inability of the LES to open can be caused by cancer where
the stomach meets the esophagus. This cancer can impair the nerves
that signal the LES to relax and open. In rare cases, achalasia
itself can be a precursor to cancer of the esophagus.
Treatment of achalasia includes:
- Pneumatic dilator
A ballon is positioned on the sphincter muscle of the LES and
then inflated. This manually forces the muscle to open. Although
several sessions may be required, this usually brings about
a permanent cure.
- Botox (botulinum toxin type A)
When injected directly to the esophagus, botox acts on the nerve
that control the LES, thus causing the sphincter muscle to relax
and open. This treatment is temporary and must be repeated after
If multiple attempts using the techniques above failed, then
the LES muscle can be surgically cut.
The treatments above carry inherent risks. For example, there
is a slight risk (estimated at about 2%) of puncturing the esophagus
during the pneumatic dilator procedure. Surgical cutting of the
LES permanently disables the muscle and reduces its ability to
prevent stomach acid from entering the esophagus. The long-term
risk of botox injection is not known.
Medical Encyclopedia: Achalasia