Achalasia: Causes, Symptoms, Diagnosis and Treatment

Achalasia is an uncommon disorder that makes it challenging for patients to swallow food and drinks from their mouth into their stomach (esophagus).

The esophageal nerves are damaged, which leads to achalasia. As a result, the esophagus gradually enlarges and becomes paralyzed, losing its ability to force food into the stomach. The food then builds up in the esophagus, where it can occasionally ferment before washing back up into the mouth, where it might taste bitter. This is sometimes mistaken for gastroesophageal reflux disease (GERD), according to some people. Contrary to GERD, achalasia involves food entering the stomach rather than the esophagus.

Achalasia has an unknown cause. The muscle is no longer able to contract regularly if the esophagus is paralyzed. While indications can frequently be managed with endoscopy, minimally invasive therapy, or surgery.

Causes Of Achalasia

The exact cause of achalasia is unknown. According to studies, it may be caused by the esophagus losing nerve cells. There are theories as to why this happens, however autoimmune responses or viral infections have been suggested. Rarely, an inherited genetic disorder or condition can cause achalasia.

Symptoms  Of Achalasia

The majority of the time, achalasia symptoms appear gradually and worsen over time. Warning indicators and symptoms include:

• Feelings of food or liquid being stuck in your throat can be brought on by dysphagia, or the inability to swallow.
• Spitting up saliva or food
• Heartburn
• Belching
• Intermittent chest discomfort
• Coughing at night
• Food aspiration into the lungs can result in pneumonia.
• Vomiting
• Weight loss

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Diagnosis  Of Achalasia

It's possible to miss or make an incorrect diagnosis of achalasia because its symptoms are similar to those of other digestive disorders. Checking for achalasia may be something your doctor suggests. It can be done by the following methods:

• Manometry of the esophagus: This test measures the rhythmic muscle contractions in your esophagus that take place when you swallow, as well as the flexibility of your lower esophageal sphincter as it opens or relaxes. This test is the most beneficial for determining the sort of motility difficulty you might have.
• Esophageal or upper digestive system X-rays: X-rays are taken after you swallow a chalky substance that coats and fills the inner lining of your digestive tract. The covering allows your doctor to see your esophagus, stomach, and upper intestine in silhouette. Additionally, you could be told to take a barium tablet, which might help determine whether your esophagus is obstructed.
• Upper endoscopy: An endoscope, a small, flexible tube with a light and camera, is inserted by your doctor to inspect the interior of your esophagus and stomach. Endoscopy can be used to find out if there may be a partial blockage of the esophagus based on your symptoms or the results of a barium study. To test for reflux-related conditions like Barrett's esophagus, an endoscopy procedure called a biopsy may also be utilized to obtain a tissue sample.

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Treatment  Of Achalasia

Treatment for Achalasia focuses on relaxing or stretching open the lower esophageal sphincter to improve the ease with which food and liquids flow through the digestive tract.

Your age, state of health, and degree of achalasia will all affect the sort of treatment you receive.

Non-surgical treatment

Non-surgical options include

• Pneumatic expansion: A balloon is inserted into the core of the esophageal sphincter and inflated during endoscopy to enlarge the opening. This outpatient procedure might need to be repeated if the esophageal sphincter doesn't stay open. About one-third of patients who underwent balloon dilation treatment need a follow-up operation within five years. For this procedure, sedation is required.
• Botox, or type A botulinum toxin: This muscle relaxant can be injected right into the esophageal sphincter using an endoscopic needle. Repeating the injections might be essential, and in such cases, doing so might make it more difficult to perform surgery in the future.
  • Botox is often recommended only for those who would be poor candidates for pneumatic dilation or surgery due to age or general health. Botox treatments often last no longer than six months. A significant improvement after receiving a Botox injection could help to confirm the diagnosis of achalasia.
• Medication: Your doctor could recommend taking muscle relaxants like nitroglycerin (Nitrostat) or nifedipine (Procardia) before meals. These medications offer limited therapeutic efficacy and have serious negative effects. When Botox has failed and you are not a candidate for pneumatic dilation or surgery, medicines are frequently the only option. This form of therapy is hardly required.

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Surgery

Surgical options for treating achalasia include the ones listed below:

• The Heller Myotomy: The surgeon cuts the muscle at the lower end of the esophageal sphincter to make it simpler for food to enter the stomach. The surgery can be finished with a minimally invasive procedure called laparoscopic Heller myotomy. Some patients who undergo a Heller myotomy may later develop gastroesophageal reflux disease (GERD).
  • Future GERD problems may be avoided by combining a Heller myotomy with the procedure known as fundoplication. The surgeon conducts a fundoplication, wrapping the top of your stomach around the lower esophagus, to create an anti-reflux valve and prevent acid reflux disease (GERD) from entering the esophagus. Fundoplication is typically performed using a minimally invasive (laparoscopic) technique.
• Peroral endoscopic myotomy (POEM). During the POEM procedure, the surgeon inserts an endoscope into your mouth and down your throat to make an incision in the inner lining of your esophagus. The lower esophageal sphincter's muscle is then sliced by the surgeon, just like in a Heller myotomy.

POEM can be used in conjunction with or just after a subsequent fundoplication to help prevent GERD. Some patients with a POEM who also have GERD are treated with daily oral medication after the operation.

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