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 when sleeping
  • 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.

  • Endoscopy
    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.

Achalasia Causes

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.

Achalasia Treatment

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 several months.

  • Surgery
    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.

MedlinePlus Medical Encyclopedia: Achalasia
eMedicine: Achalasia

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