Many of us like a good meal, but for some, eating causes more discomfort than joy. A disease of the esophagus called achalasia makes it difficult and painful for some people to swallow food, said Dr. Abhinav Sankineni with the Center for Digestive Disease at MedStar Franklin Square Medical Center.
What is achalasia?
Achalasia is a disease of the esophagus, the tube that delivers food from the mouth to the stomach. In the lower part of the esophagus where it opens into the stomach, there is a valve called the lower esophageal sphincter (LES). This sphincter opens when there is food in the esophagus that then is transferred to the stomach. If this sphincter does not open and the food cannot move into the stomach, it could be the dysfunctional contraction of the esophagus and/or the incomplete opening of the lower esophageal sphincter into the stomach. The result is that food cannot move to where it needs to go — the stomach. The condition could be related to damaged nerves in the esophagus or damage to the LES.
The disorder can cause not only discomfort, pain and weight loss, but can impact the quality of life of a person suffering with achalasia.
Achalasia may be hereditary, or it may be caused by an autoimmune disease. Only a doctor can determine why the nerves degenerate in a patient leading to the disorder.
What are the symptoms and how is achalasia diagnosed?
Since achalasia prevents food from advancing to the stomach, the patient experiences trouble swallowing solid and liquid food and they most often complain of the sensation of food being stuck in their chest. This is also known as dysphasia. The response naturally is to cough, spit up food, aspirate or inhale food into their lungs, and that in turn causes lung infection or pneumonia.
Most patients complain of chest pain and heartburn.They may also experience weight loss. Patients with suspected achalasia will need to undergo a procedure called an upper endoscopy. During this procedure, the patient is sedated and asleep. The doctor puts a thin tube with a camera through the patient's mouth, down into the esophagus and stomach. This is an important step in ruling out stomach cancer. If there is no evidence of tumor or a mass in the stomach, patients may need further evaluation with specialized testing of the esophagus called esophageal manometry and barium swallow, which assess esophageal contractions and also evaluate the lower esophageal sphincter.
For esophageal manometry, your doctor will pass a thin tube with pressure sensors through your nose into the esophagus and down into the stomach. Patients are awake for this procedure as they need to follow instructions. This test measures esophageal contractions and also assesses the lower esophageal sphincter to see if this opens appropriately into the stomach. This test is very important to be sure that patients have achalasia. In patients with achalasia, there is dysfunctional contraction of the esophagus and the lower esophageal sphincter does not open completely resulting in food being stuck in the esophagus.
Barium swallow is a test where you drink a contrast, and pictures of the contrast are taken as it moves down the esophagus into the stomach. In achalasia, the contrast either does not move into the stomach or there is slow movement of the contrast into the stomach.
Who is more likely to be diagnosed with achalasia?
This disease is predominantly seen in patients between ages 25 and 60. It affects men and women equally. The majority of the time, there is no clear cause, however it can be seen in older patients in association with stomach, pancreatic, lung or gland cancers, This disease can also be associated with an infection with a parasite called Trypanosoma cruzi (Chagas disease), which is more commonly seen in Mexico, Central America and South America.
Can achalasia lead to other problems, such as malnutrition and acid reflux?
When food gets backed up in the esophagus, it may result in chest pain and vomiting. Sometimes vomited food goes into the lungs causing lung infection or pneumonia. Patients with achalasia also tend to lose weight and become malnourished.
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How is it treated?
While there is no cure for achalasia, there are ways to treat it that will offer relief of the symptoms. Achalasia can be treated with either upper endoscopy or laparoscopic surgery for long-term relief of symptoms. The goal is to disrupt the muscle in the lower part of the esophagus which opens into the stomach, which can help move the food into the stomach.
During an upper endoscopy, your doctor will pass a thin tube with camera through your mouth into the esophagus and stomach. A thin wire is passed into the stomach and the camera tube is removed. A deflated balloon is passed over the wire until it reaches the muscle in lower part of the esophagus which opens into the stomach. The balloon is inflated to disrupt the muscle in the lower part of the esophagus to help food move into the stomach. Balloon is deflated and removed with the wire.
A surgeon can also cut the muscle in the lower part of the esophagus. This is usually performed laparoscopically.
Patients who are very sick and high-risk for surgery who cannot undergo such invasive therapies may need medicines that can relax the muscle in the lower part of esophagus. They can also get a shot of medicine into the muscle to make it relax.