What is Achalasia?

Achalasia is a rare swallowing disorder that affects the esophagus (the tube between the throat and the stomach). In people with achalasia, the esophagus muscles do not contract properly and do not help propel food down toward the stomach. At the same time, the ring of muscle at the bottom end of the esophagus, called the lower esophageal sphincter (LES), is unable to relax to let the food into the stomach.

Achalasia typically affects adults between 30 and 60 years of age, with a peak in the 40s. The disorder is about twice as common in men than women.

Symptoms of Achalasia

Symptoms can occur a bit differently in each person. They develop over time as the esophagus becomes wider and weaker. Symptoms can include:

• Trouble swallowing food (dysphagia)
• Food or liquid flowing back up into your throat (regurgitation)
• Waking up at night coughing or choking due to regurgitation
• Heartburn
• Chest pain or pressure
• Trouble burping
• Hiccups
• Weight loss

The symptoms of achalasia may be like other health conditions. Always see your healthcare provider for a diagnosis

Causes of Achalasia

The causes of achalasia are unknown, but researchers are exploring several theories. One is related to degeneration of the nerve cells located between the layers of esophageal muscles. These nerve cells enable the esophagus to push food toward and into the stomach.

Some studies suggest a possible relationship between achalasia and parasitic or viral infections. People with achalasia may be more likely to show evidence of previous infections, such as antibodies to the herpes simplex virus, human papillomavirus, measles virus and others.

There is also evidence that achalasia may be an inflammatory autoimmune disorder, which means it could be caused by the body attacking itself. Researchers have seen signs of immune system activity in the nerve cells that empower esophageal muscles. Also, patients with achalasia are 3.6 times more likely to have an autoimmune disorder such as uveitis, type I diabetes, rheumatoid arthritis, systemic lupus erythematosus and Sjögren’s Syndrome.

How is Achalasia Diagnosed?

Your healthcare provider will ask about your symptoms and health history. Your provider will give you a physical exam. You may also have tests, such as:

Endoscopy: A flexible lighted tube is passed through your mouth to look at your esophagus and the lower esophageal sphincter (LES).

Esophogram: This is a type of X-ray that takes pictures of your esophagus while you swallow a thick contrast material called barium. You may swallow a barium tablet as well. The radiologist looks for signs of achalasia. These include widening of the esophagus, incomplete emptying, and tightness of your LES.

Manometry: A thin tube that measures pressure is passed through your nose down into your esophagus. Pressure measurements are taken as you swallow sips of water. This test can show if the muscles in your esophagus are weak and don’t work well. The test can also show pressure buildup at your LES. This test confirms a diagnosis of achalasia.

What are Possible Complications of Achalasia?

Treatment can help prevent long-term complications such as:

Aspiration Pneumonia: This is caused when food or liquids in your esophagus back up into your throat and you breathe them into your lungs.

Esophageal Perforation: This is a hole in the esophagus. It may happen if the walls of your esophagus become weak and bulge. It may also happen during treatment. Esophageal perforation may cause a life-threatening infection.

Esophageal Cancer: People with achalasia are at higher risk for this type of cancer.

How is Achalasia Treated?

There’s no known cure for achalasia. But treatments can manage your symptoms. Talk with your healthcare provider about the risks, benefits, and possible side effects of all treatments. Treatment can:

• Ease your symptoms
• Open up your LES so your esophagus empties more easily
• Help prevent complications

You may also need repeat treatments. Treatment may include the following.

Living with Achalasia

Achalasia is a chronic condition. But you can manage it by working with your healthcare provider to create a treatment plan. Your healthcare team will need to see you 1 or 2 times a year, even after your symptoms have lessened. You may need repeat endoscopy and esophogram procedures.

If you have symptoms of dysphagia or regurgitation:

• Stop smoking
• Don’t eat foods or have drinks that give you heartburn
• Drink plenty of fluids when eating. Chew your food well
• Eat smaller meals more often
• Don’t overeat late at night
• If you have symptoms at night, prop up the head of your bed

Key Points about Achalasia

• Achalasia is a swallowing disorder that affects the esophagus. The muscles of the esophagus don’t work well at pushing food or liquid into your stomach.
• Achalasia usually develops slowly. It becomes harder to swallow food and drinks over time.
• Symptoms can include trouble swallowing food and food or liquid flowing back up into your throat.
• You may have tests, such as an endoscopy or esophogram.
• There is no known cure. But treatments can manage your symptoms. Treatment may include pneumatic dilation, botulinum toxin injections, surgery, or medicines.

Next Steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen
• Before your visit, write down questions you want answered
• Bring someone with you to help you ask questions and remember what your provider tells you
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you
• Know why a new medicine or treatment is prescribed and how it will help you. Also know what the side effects are
• Ask if your condition can be treated in other ways
• Know why a test or procedure is recommended and what the results could mean
• Know what to expect if you do not take the medicine or have the test or procedure
• If you have a follow-up appointment, write down the date, time, and purpose for that visit
• Know how you can contact your provider if you have questions

Is there an Achalasia Diet?

No diet is proved to help with achalasia symptoms, but you should discuss with your doctor or a speech-language pathologist if you should change what you eat. Certain foods can be harder or less difficult to swallow depending on the type of achalasia you have. Also, if you have lost much weight because of achalasia, your doctor may recommend high calorie foods to make sure you have a healthy body mass index.

Some people with achalasia feel better when avoiding certain foods, such as:

• Raw fruits and vegetables
• Tough cuts of meat
• Highly acidic foods such as citrus fruits
• Alcohol
• Caffeine

How and when you eat can make a difference too. Small bites of food, chewed carefully, can be easier to swallow. Avoiding solid foods before bedtime can minimize nighttime chest pain and regurgitation.

Reference:

https://www.hopkinsmedicine.org/health/conditions-and-diseases/achalasia

https://www.cedars-sinai.org/health-library/diseases-and-conditions/a/achalasia.html