Achalasia

Definition

Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.

Alternative Names

Esophageal achalasia

Causes, incidence, and risk factors

A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.

Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease may have symptoms like those of achalasia.

Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults. This problem may be inherited in some people.

Symptoms

• Backflow (regurgitation) of food
• Chest pain, which may increase after eating or may be felt in the back, neck, and arms
• Cough
• Difficulty swallowing liquids and solids
• Heartburn
• Unintentional weight loss

Signs and tests

Physical examination may show signs of anemia or malnutrition.

Tests include:

• Esophageal manometry
• Esophagogastroduodenoscopy
• Upper GI x-ray

Treatment

The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

• Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.
• Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter
• Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter
• Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)

Your doctor can help you decide which treatment is best for your situation.

Support Groups

Expectations (prognosis)

The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary.

Complications

• Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
• Breathing food contents into the lungs, which can cause pneumonia
• Tearing (perforation) of the esophagus

Calling your health care provider

Call your health care provider if:

• You have difficulty swallowing or painful swallowing
• Your symptoms continue even with treatment for achalasia

Prevention

Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

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References

Orlando RC. Diseases of the esophagus. In: Goldman L, Ausiello DA, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 140.