Esophageal Achalasia
Key points
- Achalasia is a disorder of the esophagus (the tube that carries food from the mouth to the stomach).
- The main abnormality in achalasia is a failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing.
- An upper GI x-ray test or barium esophagogram may show absence of peristalsis, a dilated proximal esophagus, and a narrowing at the bottom of the esophagus.
- The approach to treatment is to reduce the pressure at the lower esophageal sphincter.
Alternative names
Achalasia
Definition
Achalasia is a disorder of the esophagus (the tube that carries food from the mouth to the stomach). The esophagus is less able to move food toward the stomach, and the valve from the esophagus to the stomach does not relax as much as it needs to during swallowing. This relaxation is needed to allow food to enter the stomach.
Causes, incidence, and risk factors
The main abnormality in achalasia is a failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing. The disorder is characterized by loss of the wave-like contraction of smooth muscles that forces food through the digestive tract. (These contractions are called peristalsis.)
Another part of the disorder is lack of nervous stimulation to the esophagus. Causes include damage to the nerves to the esophagus, parasitic infection, cancers, and hereditary factors. Achalasia is a rare disorder, may occur at any age, but is most common in middle-aged or older adults.
Symptoms
- Difficulty swallowing liquids and solids
- Regurgitation of food
- Chest pain which may increase after eating or may radiate to the back, neck, and arms
- Unintentional weight loss
- Heartburn
- Cough
Signs and tests
An upper GI x-ray test or barium esophagogram may show absence of peristalsis, a dilated proximal esophagus, and a narrowing at the bottom of the esophagus. The diagnosis is confirmed with esophageal manometry. Physical examination may show signs of anemia.
Treatment
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter with special instruments.
Therapy usually involves dilation of the lower sphincter or injection with botulinum toxin to paralyze it and prevent spasms. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter.
Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.
Expectations (prognosis)
Surgical outcomes are good - dilation alone often results in only temporary improvement in symptoms.
Written and revised by
David Cohen, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.