Achalasia

Overview

Achalasia is a condition that affects the muscle of the esophagus, or swallowing tube. It’s a rare disease that makes it hard for food and drink to move from the throat to the stomach. Achalasia is also called a motility disorder because it affects how food moves through the digestive system.

In normal digestion, the muscles in the esophagus contract and squeeze food and drink towards the stomach. At the end the of the esophagus is a ring of muscle called the lower esophageal sphincter. This muscle relaxes to let contents into the stomach.

Achalasia can make the muscles in the esophagus too weak to contract. It can also cause the sphincter muscle to be too tight and not open. As a result, food and liquid get stuck, leading to a variety of issues.

Achalasia causes

The esophagus contains muscles and nerves. Nerves are controlled by signals sent to and from the brain. Achalasia occurs because the nerves fail to tell the brain to make the esophagus muscles work.

While the exact reason this happens is unknown, achalasia may be caused by:

• Autoimmune reaction that makes the body attack healthy tissue
• Genetic or inherited factors
• Infectious disease called Chagas, caused by a parasite (found in South America)
• Viral infection

Achalasia risk factors

It appears achalasia affects men and women equally, except when it’s inherited. In those cases, it seems to affect men more than women.

While most cases occur in adults between 30 and 60 years old, infants and children can have achalasia as well.

Achalasia sometimes happens along with other conditions, such as autoimmune disorders, Down syndrome and Allgrove syndrome. More research is needed.

Achalasia symptoms

Achalasia symptoms can be mild or non-specific for a few years and may appear gradually.

One of the first symptoms of achalasia is trouble swallowing, called dysphasia. Other symptoms and complications include:

• Chest pain
• Coughing, especially night
• Difficulty burping
• Feeling fullness in the throat
• Heartburn
• Regurgitation, or spitting up undigested or partially digested food or liquid
• Weight loss

Achalasia diagnosis

Achalasia is a progressive disease, which means it can get worse over time. If you have symptoms of achalasia, your doctor may order certain tests, including:

• Barium swallow, or a video X-ray of the esophagus after drinking a liquid form of barium.
• Endoscopy, or a view inside the esophagus using a flexible tube with a camera at the end.
• Esophageal manometry, or a tube placed in the esophagus that measures muscle activity while you swallow.

Achalasia treatment

Left untreated, achalasia can cause serious damage to the muscle and nerves in the esophagus.

Treatment includes non-surgical and surgical options to improve the flow of food and liquid through the esophagus. These include:

• Medicines, such as nitrates or calcium blockers, to help relax the sphincter muscle.
• Botulism toxin injections to weaken the sphincter muscle.
• Dilation to stretch the sphincter muscle using a tube with a balloon at the end inserted through the mouth.
• Esophagomyotomy using different surgical techniques, such as a Heller myotomy, to cut or alter the sphincter muscle.

When to seek care

If you experience any of these symptoms, start by voicing your concerns and symptoms to your primary care provider. From there, they may suggest seeing a gastroenterologist for more specialized treatment.