Achalasia is a rare neurological disorder that affects the esophagus, causing difficulty in swallowing food and liquid. It is characterized by a failure of the lower esophageal sphincter (LES) to relax during swallowing, leading to the accumulation of food and liquid in the esophagus. This condition affects both genders and all age groups, but it is more commonly seen in people between the ages of 25 and 60.
Pathophysiology: The cause of achalasia is not entirely understood, but it is thought to be due to degeneration of the nerve cells that control the muscles of the esophagus, leading to a loss of peristalsis and poor relaxation of the LES. In addition, there may be an immune component that causes inflammation and damage to the nerves that control the esophagus.
Signs and Symptoms: The hallmark symptom of achalasia is dysphagia, which refers to difficulty in swallowing food and liquid, especially solid food. Other symptoms may include regurgitation, chest pain, heartburn, and weight loss. Patients may also experience a sensation of food sticking in the chest or throat.
Investigation: The diagnosis of achalasia is usually made by a combination of clinical symptoms, radiographic studies, and endoscopy. A barium swallow X-ray may show a dilated esophagus with a narrow LES, and esophageal manometry can confirm the lack of peristalsis and poor relaxation of the LES. Endoscopy is important to exclude other causes of dysphagia and assess for complications such as esophagitis and strictures.
Treatment: There is no cure for achalasia, but treatment aims to alleviate symptoms and improve esophageal function. Options include:
Medications such as calcium channel blockers and nitrates to relax the LES and improve swallowing function.
Endoscopic therapy such as pneumatic dilation or botulinum toxin injection can also help to relax the LES and improve symptoms.
Surgery such as a Heller myotomy, which involves cutting the muscles at the LES to allow easier passage of food and liquid.
Dos and Don’ts: Patients with achalasia should avoid eating large meals and consuming foods that are difficult to swallow. They should also avoid lying down after meals to prevent regurgitation. Patients should aim to eat slowly, take small bites, and drink plenty of fluids with meals.
Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238-49. doi: 10.1038/ajg.2013.196.
Kahrilas PJ, Boeckxstaens G, Smout AJ. Management of the patient with incomplete response to therapy for achalasia. Ann Surg. 2013;258(2):215-20. doi: 10.1097/SLA.0b013e3182969ba9.