What is achalasia?
Achalasia, also called cardiospasm, is a rare disorder that makes it difficult for food and liquid to pass into your stomach. Achalasia occurs when the food tube (esophagus) loses the ability to squeeze food down, and the muscular valve between the esophagus and stomach doesn’t fully relax. The cause of achalasia is unknown; however, there is degeneration of the esophageal muscles and, more importantly, the nerves that control the muscles.
Complications of achalasia include lung problems and weight loss. Achalasia may increase the risk of cancer of the esophagus, but this not well established.
How common is achalasia?
Achalasia is a rare disease that can affect both males and females. It can affect patients at any age, but is more common in older people. It can be managed by reducing your risk factors. Please discuss with your doctor for further information.
What are the symptoms of achalasia?
The main symptom of achalasia is difficulty in swallowing or chest pain when swallowing (dysphagia). You can also experience weight loss because of difficulty eating due to pain. Other symptoms of the disease may include chest pain, coughing, wheezing, heartburn, belching and vomiting. For some cases, you also may have backflow (regurgitation) of your food.
People with achalasia will often have trouble swallowing or feel like food is stuck in their esophagus. This is also known as dysphagia. This symptom can cause coughing and raises the risk of aspiration, or inhaling or choking on food. Other symptoms include:
- Pain or discomfort in your chest
- Weight loss
- Intense pain or discomfort after eating
- Difficulty swallowing both solid and liquid food
- Chest discomfort from esophageal dilation and/or retained food
- Sharp chest pain usually of unclear cause
- Heartburn; however, the heartburn is not characteristic of heartburn and is not helped by treatment for heartburn
- Loss of weight due to reduced intake of food
You might also have regurgitation or backflow. However, these can be symptoms of other gastrointestinal conditions such as acid reflux.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes achalasia?
Although the exact cause is unknown, achalasia is a result of nerve damage of the esophagus. There is a muscular ring at the point where the esophagus and stomach meet, called the lower esophageal sphincter. Normally, this muscle relaxes when you swallow. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophagus (peristalsis) is reduced.
This condition may be hereditary, or it may be the result of an autoimmune condition, which occurs when your body’s immune system mistakenly attacks healthy cells in your body. The degeneration of nerves in your esophagus often contributes to the advanced symptoms of the condition.
Other conditions can cause symptoms similar to achalasia. Cancer of the esophagus is one of these conditions. Another cause is a rare parasitic infection called Chagas’ disease. This disease occurs mostly in South America.
What increases my risk for achalasia?
Since the cause of the nerve damage is unknown, the risk factors have not been clearly identified. Some factors that can contribute are:
- People who are middle-aged and older;
- People with autoimmune disorders.
If you have any questions about any risk factor, you should discuss with your doctor for more information.
Diagnosis & Treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is achalasia diagnosed?
Your doctor might suspect you have achalasia if you have trouble swallowing both solids and liquids, particularly if it gets worse over time.
Your doctor may use esophageal manometry to diagnose achalasia. This involves placing a tube in your esophagus while you swallow. The tube records the muscle activity and makes sure your esophagus is functioning properly.
For the diagnosis, the doctor may specify barium swallow X-rays (before X-rays, you will drink a liquid called barium white or reflective to swallow a liquid can be seen on X optical). Barium swallow x-rays will show a narrow portion of the lower esophagus and esophageal width on your part. This procedure, also known as X-ray upper gastrointestinal contrast-enhanced.
Doctors also use measurement methods to determine the pressure in the esophagus with or without activity and increase pressure on the lower esophageal sphincter to you.
Colonoscopy (using a small tube mounted lights, together with a small camera at the top of the tube) can check sphincter can tighten or not.
Also, to check signs of tumor, the doctor may request a biopsy, a tissue sample that is taken and examined under a microscope.
How is achalasia treated?
Achalasia has no cure, but treatment can improve the condition and prevent complications.
If you suffer from achalasia, you should reduce the pressure at the lower esophageal sphincter. The first line of treatment is often oral medications. Nitrates or calcium channel blockers can help relax the sphincter so food can pass through it more easily. Your doctors might also use Botox to relax the sphincter.
To treat achalasia more permanently, your doctors can either dilate the sphincter or alter it. Dilation typically involves inserting a balloon into your esophagus and inflating it. This stretches out the sphincter and helps your esophagus function better. However, sometimes dilation tears the sphincter. If this happens, you may need additional surgery to repair it.
Doctor may suggest injecting Botox (botulinum toxin) in the sphincter to widen esophagus.
Esophagomyotomy is a type of surgery that can help you if you have achalasia. Your doctor will use a large or small incision to access the sphincter and carefully alter it to allow better flow into the stomach. The great majority of esophagomyotomy procedures are successful. However, some patients have problems afterward with gastroesophageal reflux disease (GERD). If you have GERD, your stomach acid backs up into your esophagus. This can cause heartburn.
Treatment can be highly successful. Multiple treatments are sometimes necessary. Surgery may be necessary if a dilation procedure doesn’t work the first time. Usually, the chance of success decreases with each successive dilation. Therefore, your doctor will probably seek alternatives if several dilations are unsuccessful.
Lifestyle changes & Home remedies
What are some lifestyle changes or home remedies that can help me manage achalasia?
The following lifestyles and home remedies might help you manage your achalasia:
- Eat and chew slowly
- Drink liquid foods
- Drink more water with meals
- Drink carbonated beverages (the carbonation seems to help “push” the food through the esophageal sphincter)
- Re-examination appointments for monitoring progression of symptoms as well as your health
- Listen to the guidance of a doctor, not quite medication which was prescribed for you
- Call your doctor if you have dysphagia for long periods, pain when swallowing or have residual symptoms after treatment
- Call your doctor if you vomit blood or have new symptoms
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Ferri, Fred. Ferri’s Netter Patient Advisor. Philadelphia, PA: Saunders / Elsevier, 2012. Print. Page 261.
Porter, R. S., Kaplan, J. L., Homeier, B. P., & Albert, R. K. (2009). The Merck manual home health handbook. Whitehouse Station, NJ, Merck Research Laboratories. Print. Page 132.
Achalasia-series.(n.d.).MedlinePlus Medical Encyclopedia. http://www.nlm.nih.gov/medlineplus/ency/presentations/100143_1.htm. Accessed April 14, 2016.
Achalasia. (n.d.). PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001313/. Accessed April 14, 2016.
Achalasia. http://www.healthline.com/health/achalasia#Overview1. Accessed 2 Jan 2017
Achalasia. http://www.medicinenet.com/achalasia/page3.htm#what_are_the_symptoms_of_achalasia. Accessed 2 Jan 2017
Achalasia. http://www.mayoclinic.org/diseases-conditions/achalasia/basics/definition/con-20024482. Accessed 2 Jan 2017
Review Date: May 30, 2016 | Last Modified: April 12, 2017