Achalasia

Achalasia

Achalasia is a condition when the muscles of the esophagus are unable to push food or drink into the stomach. This condition makes sufferers can experience symptoms such as difficulty swallowing, food back up into the esophagus, and weight loss.

When a person eats or drinks, the ring of muscle at the bottom of the esophagus ( lower esophageal sphincter / LES) contracts to push food or drink deeper in. Furthermore, the LES will relax so that food or drink can enter the stomach.

In achalasia, the LES becomes stiff and cannot open properly. This condition causes food or drink to accumulate at the bottom of the esophagus and sometimes back up to the top of the esophagus.

Although both cause food to rise to the throat, achalasia is different from acid reflux disease ( GERD ). GERD occurs when the LES is too weak so that the esophageal muscle ring can't close.

Achalasia is a rare disease. It is estimated that this condition occurs in 1 in 100,000 people. However, achalasia can affect people of all age groups, both men and women.

Causes of Achalasia

It's not known what causes achalasia, but it is suspected that achalasia is linked to the following conditions:

  • Autoimmune disease
  • Family history
  • Decreased nerve function
  • viral infection

In addition to the above conditions, achalasia can also occur as a complication of Chagas disease , gastric cancer , and lymphoma.

achalasia risk factors

Achalasia can happen to anyone. However, there are a number of factors that can increase a person's risk of developing achalasia:

  • 30–60 years old
  • Having a spinal injury
  • Undergoing treatment for varicose veins (sclerotherapy)
  • Suffering from Down syndrome

Symptoms of Achalasia

Symptoms of achalasia appear gradually. Over time, the function of the esophagus in people with achalasia will get weaker and the following symptoms will appear:

  • Frequent burping
  • Difficulty swallowing or dysphagia
  • Weight loss
  • Food back up into the esophagus or regurgitation
  • Hot sensation in the chest ( heartburn )
  • Chest pain that comes and goes
  • Cough at night
  • Vomit

When to go to the doctor

Immediately see a doctor if you experience the above symptoms. If left untreated, untreated achalasia can increase the risk of the sufferer developing esophageal cancer .

If you've been diagnosed with achalasia, talk to your doctor about a proper diet. You should also see a doctor if symptoms persist despite receiving medical treatment.

The symptoms of achalasia are similar to the symptoms of other digestive disorders, such as GERD. By seeing a doctor, you will get the right diagnosis and treatment.

Diagnosis of Achalasia

To diagnose achalasia, the doctor will first ask about the patient's symptoms and medical history. After that, the doctor will perform a physical examination of the patient's ability to swallow food or drink.

Furthermore, the doctor may perform additional examinations, such as:

  • Esophagography , to get a detailed picture of the esophagus, stomach and intestines by drinking Barium liquid
  • Manometry, to measure the flexibility and strength of the muscle contractions of the esophagus when swallowing
  • Endoscopy , to examine the condition of the walls of the esophagus and stomach

Achalasia Treatment

Acalasia treatment aims to relax the LES muscle so that food and drink can enter easily into the stomach. Methods of treatment can be done with non-surgical measures or surgical procedures, as described below.

Non-surgical measures

A number of non-surgical measures that can be taken to treat achalasia are:

  • Pneumatic dilation
    Pneumatic dilation is a procedure to widen the esophagus by inserting a special balloon into the narrowed part of the esophagus. This procedure needs to be done about five times to get the best results.
  • Botulinum toxin injections Botulinum toxin ( botox
    ) injections are used to relax the esophageal muscles for patients who cannot undergo pneumatic dilation . The effect of Botox injections only lasts a maximum of 6 months so it needs to be repeated.
  • Administration of muscle relaxants
    Drugs used include nitroglycerin and nifedipine. Muscle relaxants are given to patients who cannot undergo pneumatic dilation or surgery, or when botox injections are not effective in treating achalasia.

Surgical procedure

Some surgical procedures that doctors can choose to treat achalasia are:

  • Heller myotomy
    This procedure is performed by cutting the LES muscle using a laparoscopic technique . Heller myotomy can be performed in conjunction with a fundoplication procedure , to reduce the risk of future GERD attacks.
  • Fundoplication
    Fundoplication
     is a procedure to wrap the lower part of the esophagus with the upper part (fundus) of the stomach. The goal is to prevent stomach acid from rising into the esophagus.
  • Peroral endoscopic myotomy (POEM)
    POEM is a procedure that cuts the LES muscle directly from the inside of the mouth. This procedure is performed with the help of a camera tube that is inserted through the mouth (endoscope).

Achalasia Complications

Untreated achalasia can lead to a number of complications, including:

  • Aspiration pneumonia , which occurs due to the entry of food or drink into the lungs, causing infection
  • Inflammation of the lining of the esophagus or esophagus ( esophagitis )
  • Tearing of the wall of the esophagus (esophageal perforation)
  • Esophageal cancer

Achalasia Prevention

Achalasia is difficult to prevent. However, if you have achalasia, there are several things you can do to prevent symptoms from appearing, including:

  • Drink more water while eating
  • Chew food until it is completely smooth before swallowing
  • Avoid consuming foods or drinks that can trigger a burning sensation in the chest ( heartburn ), such as chocolate, oranges, and spicy foods
  • Eat small portions but often, rather than eating infrequently but eating at once in large portions
  • Avoid eating at night, especially if it is close to bedtime
  • Supporting the head with a pillow while sleeping, to prevent stomach acid from rising into the esophagus
  • Do not smoke
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