Achalasia is a rare esophageal motility disorder that affects the esophagus, which connects the throat to the stomach. It can cause symptoms such as regurgitation of food into the mouth, difficulty swallowing solids and liquids, and weight loss.
The exact cause of achalasia is unknown, but it is believed to be related to damage to the nerves in the esophagus. This damage prevents the lower esophageal sphincter from relaxing properly during swallowing, making it harder for food to enter the stomach.
As a result, food can remain in the esophagus, causing it to widen and increasing pressure inside it. Treatment is managed by a gastroenterologist and may include medications to relieve symptoms, balloon dilation, botulinum toxin injections, or surgery.
Achalasia symptoms
The main symptoms of achalasia are:
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Difficulty swallowing solids and liquids;
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Chest pain;
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Regurgitation of food into the mouth;
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Heartburn;
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Excessive belching;
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Vomiting;
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Nighttime coughing.
Weight loss may also occur because of reduced food intake and difficulty emptying the esophagus.
It is important for achalasia to be diagnosed and treated promptly to help prevent complications such as nutritional deficiencies, respiratory problems, and even esophageal cancer.
Confirming a diagnosis
Achalasia is diagnosed by a gastroenterologist based on an evaluation of symptoms and examination of the esophagus using specific tests, such as upper gastrointestinal endoscopy, a contrast X-ray of the esophagus, stomach, and duodenum, and esophageal manometry.
These tests are used not only to confirm the diagnosis of achalasia but also to determine the severity of the condition, which is important for choosing the most appropriate treatment.
In some cases, a biopsy may also be necessary to determine whether the symptoms are related to cancer or another condition.
Possible causes
The exact cause of achalasia is not fully understood, but it is believed to be related to damage to the nerves that control the muscles of the esophagus. This can lead to reduced or absent muscle contractions that normally help move food through the esophagus.
Some factors appear to increase the risk of developing achalasia, such as:
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Autoimmune conditions;
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Viral infections;
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Genetic predisposition;
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Metastatic stomach cancer;
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Eosinophilic gastroenteritis;
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Lymphoma.
Achalasia has also been reported in people with Chagas disease due to damage to the nerves of the esophagus caused by Trypanosoma cruzi, the parasite responsible for Chagas disease.
Treatment for achalasia
Treatment for achalasia should be managed by a gastroenterologist and is aimed at relieving symptoms and helping food pass properly from the esophagus into the stomach.
Treatments that may be recommended by a doctor include:
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Placement of a balloon inside the esophagus to permanently stretch the muscle fibers;
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Injection of botulinum toxin into the lower esophageal sphincter during endoscopy, which may be recommended when balloon dilation cannot be performed;
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Surgery, such as laparoscopic Heller myotomy or peroral endoscopic myotomy (POEM), to cut muscle fibers in the lower esophageal sphincter and allow food to pass more easily into the stomach.
Despite the potential for side effects, myotomy has been shown to be one of the most effective treatments for achalasia.
When balloon dilation cannot be performed, surgery is not an option, or botulinum toxin injections have not been effective, a doctor may recommend medications such as nitroglycerin or nifedipine before meals to help relax the lower esophageal sphincter and reduce symptoms.