Introduction
It is a condition characterized by difficulty emptying the oesophagus into the stomach. Achalasia occurs when nerves in the tube connecting your mouth and stomach (oesophagus) become damaged. Therefore, the oesophagus at its lower end fails to fully relax – making it difficult for food to pass into your stomach and it will often stay trapped inside the lower oesophagus.
There's no cure for achalasia. But symptoms can usually be managed with minimally invasive therapy or surgery.
Causes
Whether the cause is hereditary, infective or autoimmune, the result is the same, a damage to the nerves that relax the sphincter making it tense and tight. The oesophagus contains both muscles and nerves. The nerves coordinate the relaxation and opening of the sphincters as well as the peristaltic waves in the body of the oesophagus. It is a progressive disease which starts as inflammation of the muscles and nerves and end as a degeneration and disappearance of the nerves making the muscles not able to relax. With time the lower sphincter will dilate making its management is even more difficult.
Symptoms
The symptoms of achalasia often start slowly and progress gradually, sometimes taking years to fully develop. They include:
- Difficulty swallowing (dysphagia), which can be painful.
- A lump or feeling of fullness in the throat.
- Chest pain.
- Heartburn.
- Regurgitation of variable grades
- Coughing or choking (due to regurgitation of food), which may be worse at night.
- Hiccups.
- Difficulty burping.
- Weight loss.
Diagnosis
- Oesophageal manometry. To measure the motility, contractility and tone of all esophageal muscles.
- X-rays of your upper digestive system (Barium Swallow). X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your oesophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help to show a blockage of the oesophagus.
- Upper GI endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your oesophagus and stomach. Endoscopy can be used to define a partial blockage of the oesophagus if your symptoms or results of a barium study indicate that possibility. Endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications of reflux such as Barrett's oesophagus.
Treatment
Surgery may be recommended for younger people because nonsurgical treatment tends to be less effective in this group. Surgical options include:
- Heller’s myotomy. The surgeon cuts the muscle at the lower end of the oesophageal sphincter to allow food to pass more easily into the stomach. If it is done alone, a reflux of acids might follow as the sphincter tone is reduced.
- Laparoscopic (key hole) Partial Fundoplication. The surgeon wraps the top of your stomach around the lower oesophageal sphincter, to tighten the muscle and prevent acid reflux. It is better to be done after the Heller Myotomy during the same operation.
- Per Oral Endoscopic Myotomy (POEM). it is endoscopic release of the tight sphincter. It has its own strengths and weaknesses.
