Achalasia

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The tube that carries food from the mouth to the stomach is the esophagus also called the food pipe. Achalasia is a condition that makes it harder for the esophagus to move food into the stomach.

Prevalence of Achalasia

Achalasia is a rare disease with an annual incidence of approximately 1/100,000 and a prevalence rate of 1/10,000. The disease can occur at any age, with a similar rate in men and women, but is usually diagnosed between 25 and 60 years.

Causes of Achalasia

There is a muscular ring at the point where the esophagus and stomach meet. It is called the lower esophageal sphincter (LES). Normally, this muscle relaxes when you swallow to allow food to pass into the stomach. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophsagus (peristalsis) is reduced. Achalasia is caused by damage to the nerves of the esophagus.

Symptoms of Achalasis of the Esophagus

Symptoms of Achalasia include:

• Backflow (regurgitation) of food
• Chest pain, which may increase after eating, or may be felt as pain in the back, neck, and arms
• Cough
• Difficulty swallowing liquids and solids
• Heartburn
• Unintentional weight loss

Exams and Tests for Achalasia

Physical exam may show signs of anemia or malnutrition.

Tests for Achalasia include:

• Manometry, a test to measure if your esophagus is working properly.
• EGD or upper endoscopy, a test to examine the lining of the stomach and esophagus. It uses a flexible tube and camera.
• Upper GI x-ray.

Diagnosis of Achalasia

The diagnosis is based on history of the disease, radiography (barium esophagogram), and esophageal motility testing (esophageal manometry). Endoscopic examination is important to rule out malignancy as the cause of achalasia.

Treatment of Achalasia

The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids to pass easily into the stomach. 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.

Medicines, such as long-acting nitrates or calcium channel blockers -- These drugs can be used to relax the lower esophagus sphincter. But there is rarely a long-term solution to treat achalasia.

• Surgery (called a myotomy) -- In this procedure, the lower sphincter muscle is cut.
• Widening (dilation) of the esophagus -- This is done during EGD by stretching the LES with a balloon dilator.

Prognosis of Achalasia

The outcomes of surgery and non-surgical treatments are similar. More than one treatment is sometimes necessary.

Possible Complications of Achalasia

Complications may include:

• Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
• Breathing food contents into the lungs (aspiration), which can cause pneumonia
• Tearing (perforation) of the esophagus