What is Achalasia?
Achalasia is a rare disorder that makes it difficult for food and liquid to pass into your stomach. Achalasia occurs when nerves in the tube connecting your mouth and stomach (esophagus) become damaged. As a result, the esophagus loses the ability to squeeze food down, and the muscular valve between the esophagus and stomach (lower esophageal sphincter) doesn’t fully relax — making it difficult for food to pass into your stomach.
Esophageal achalasia is an esophageal motility disorder.
Achalasia is a chronic disease in which the nerve function deteriorates over time.
There’s no cure for achalasia. But symptoms can usually be managed with minimally invasive therapy or surgery.
The color for Achalasia is lime green.
Is Achalasia an autoimmune disorder?
Achalasia is a rare disease — it affects 1 in 100,000 people — characterized by a loss of nerve cells in the esophageal wall. While its cause remains unknown, a study in 2014 by a team of researchers, confirms for the first time that achalasia is autoimmune in origin. The study, published on 6 July in Nature Genetics, is an important step towards unraveling the mysterious disease.
Read more about this study.
What causes Achalasia?
This condition may be:
- or it may be the result of an autoimmune disorder. With an autoimmune disorder, 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 achalasia.
In the early stages of achalasia, inflammation can be seen (when examined under the microscope) in the muscle of the lower esophagus, especially around the nerves. As the disease progresses, the nerves begin to degenerate and ultimately disappear, particularly the nerves that cause the lower esophageal sphincter to relax. Still later in the progression of the disease, muscle cells begin to degenerate, possibly because of the damage to the nerves. The result of these changes is a lower sphincter that cannot relax and muscle in the lower esophageal body that cannot support peristaltic waves. (Peristalsis, involuntary movements of the longitudinal and circular muscles, primarily in the digestive tract but occasionally in other hollow tubes of the body, that occur in progressive wavelike contractions. Peristaltic waves occur in the esophagus, stomach, and intestines.) With time, the body of the esophagus stretches and becomes enlarged (dilated).
Achalasia usually occurs later in life, but it can also occur in children. Individuals who are middle-aged and older are at higher risk for the condition. Achalasia is also more common in people with autoimmune disorders.
Symptoms of Achalasia
A person with Achalasia may notice:
- Dysphagia, or difficulty in swallowing both liquid and food
- Regurgitation of indigested food, and later, liquid
- Coughing, especially when lying down
- Chest pain, similar to heartburn, which can be confused with a heart attack
- Aspiration, when food, liquid, and saliva are inhaled into the lungs
Diagnosis of Achalasia
The diagnosis of achalasia often is suspected on the basis of the history. Patients usually describe a progressive (worsening) of swallowing (dysphagia) for solid and liquid food over a period of many months to years. They may note regurgitation of food, chest pain, or loss of weigh.
Three tests that a doctor may schedule you for to diagnose this disorder.
- X-Ray and Barium swallow – X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine.
- Esophageal manometry – A thin tube that measures the pressure generated by the contracting esophageal muscle is passed through the nose, down the back of the throat and into the esophagus. In a patient with achalasia, no peristaltic waves are seen in the lower half of the esophagus after swallows, and the pressure within the contracted lower esophageal sphincter does not fall with the swallow. In patients with vigorous achalasia, a strong simultaneous contraction of the muscle may be seen in the lower esophageal body. An advantage of manometry is that it can diagnose achalasia early in its course at a time at which the video-esophagram may be normal.
- Endoscopy – Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach.
How do you treat Achalasia?
Treatments for achalasia include:
- Oral medications
- Stretching of the lower esophageal sphincter (dilation)
- Surgery to cut the sphincter (esophagomyotomy)
- The injection of botulinum toxin (Botox) into the sphincter
Is there a diet for Achalasia?
There is no specific diet for treating achalasia, though dietary alterations often are made by patients as they learn what foods seem to pass more easily. Usually, the more liquid foods pass more easily, and patients sometimes drink more water with their meals.