What is Achalasia?
Achalasia is a disorder of the esophagus, the tube that carries food from the mouth to the stomach. This condition affects the ability of the esophagus to move food into the stomach.
What Causes Achalasia?
Achalasia can happen for different reasons. It can be difficult for doctors to point out specific causes. This condition may be hereditary, or it may be caused by an autoimmune condition, where the body attacks itself. Degeneration of nerves in the esophagus often contributes to the advanced symptoms of the condition.
Other conditions can cause symptoms similar to achalasia. Cancer of the esophagus is one of these conditions. Another is a rare parasitic infection called Chagas disease.
Symptoms of Achalasia
- Backflow (regurgitation) of food
- Chest pain, which may increase after eating or may be felt in the back, neck, and arms
- Difficulty swallowing liquids and solids
- Unintentional weight loss
Who is at Risk of Achalasia?
Achalasia usually occurs later in life. Individuals middle-aged and older are at higher risk for the condition. Achalasia is also more common in people with a family history of the condition and people with autoimmune disorders.
Treatment of Achalasia
The goal of treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:
- Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
- Medications, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
- Surgery (called an esophagomyotomy). This procedure may be needed to decrease the pressure in the lower sphincter.
- Widening (dilation) of the esophagus at the location of the narrowing. This is done during esophagogastroduodenoscopy.
Your doctor can help you decide which treatment is best for you.
What Can Be Expected in the Long Term?
Prognosis for this condition varies. Some people only have very mild symptoms. For others, treatment can be highly successful. Sometimes multiple treatments are needed to handle symptoms.
Unfortunately, if a dilation procedure doesn’t work the first time, surgery may be needed. Usually, the chance of success decreases with each successive dilation. Therefore, doctors will often seek alternatives if several dilations are not successful.
The success rate for esophagomyotomy is thought to be 80-90%. However, patients may develop some complications. These include:
- issues related to tearing of the esophagus
- acid reflux
- respiratory conditions caused by food travelling up the esophagus and into the windpipe