Achalasia: An Overview
Achalasia is a rare disorder of the oesophagus, the tube that carries food from the mouth to the stomach. It affects the ability of the oesophagus to move food toward the stomach and causes difficulty swallowing.
Conditions and Symptoms
Achalasia primarily involves the lower oesophageal sphincter (LES), a ring of muscle between the oesophagus and stomach. In achalasia, the LES fails to relax properly, preventing food from passing into the stomach. Common symptoms include:
- Difficulty swallowing (dysphagia) for both solids and liquids
- Regurgitation of undigested food
- Chest pain or discomfort
- Weight loss due to eating difficulties
- Heartburn or acid reflux
- Coughing or choking, especially at night
Causes
The exact cause of achalasia is not fully understood. It is believed to result from the degeneration of nerves in the oesophagus, particularly those controlling the LES. Possible factors include:
- Autoimmune response
- Viral infections
- Genetic predisposition
Diagnosing Achalasia
Diagnosis involves several tests including:
- Barium swallow X-ray: Shows a narrowing at the lower oesophagus and a dilated oesophagus above it.
- Oesophagal manometry: Measures the pressure and muscle contractions in the oesophagus and confirms the failure of the LES to relax.
- Endoscopy: Allows direct visualisation of the oesophagus and stomach to rule out other causes of symptoms.
Treatment Options
There is no cure for achalasia, but treatments aim to relieve symptoms by improving oesophageal emptying:
- Pneumatic dilation: A balloon is inflated in the LES to stretch the muscle.
- Surgical myotomy (Heller myotomy): Cutting the muscle at the LES to allow easier passage of food.
- Peroral endoscopic myotomy (POEM): A less invasive endoscopic procedure to cut the LES muscle.
- Botulinum toxin injection: Temporarily paralyses the LES muscle to ease swallowing difficulties.
- Medications: Nitrates or calcium channel blockers may reduce LES pressure but are less effective.
Prevention
There is no known way to prevent achalasia due to its unclear cause. Early diagnosis and treatment can help manage symptoms and prevent complications such as severe weight loss or oesophageal damage.
Conclusion
Achalasia is a challenging but manageable oesophageal disorder characterised by impaired relaxation of the lower oesophageal sphincter. Understanding the symptoms and seeking timely medical evaluation can lead to effective treatments that improve quality of life.
