Understanding Achalasia: Symptoms, Causes, and Treatment Options

Achalasia is a rare disorder that affects the esophagus, the tube that carries food from your mouth to your stomach. If you have achalasia, you may experience difficulty swallowing, chest pain, and heartburn. In this article, we'll explore the causes, symptoms, and treatment options for achalasia to help you better understand and manage this condition.

What is Achalasia?

Achalasia occurs when the muscles in your esophagus don't work properly, making it difficult for food and liquids to pass into your stomach. Normally, the esophagus squeezes and relaxes to push food down, and a small valve at the bottom of the esophagus opens to allow food to enter the stomach. In people with achalasia, these processes don't function correctly, causing food to get stuck in the esophagus.

Symptoms of Achalasia

The most common symptom of achalasia is difficulty swallowing, which may occur with both solid foods and liquids. Other symptoms may include:

• Chest pain, especially after eating

• Food coming back up into the throat

• Heartburn and belching

• Weight loss

• Nighttime coughing

• Vomiting

• Pneumonia from breathing food into the lungs

Causes and Risk Factors

The exact cause of achalasia is unknown, but experts believe it may be related to genetics, autoimmune problems, viral infections, or a loss of nerve function. Achalasia can affect people of all races and is found equally in men and women. It most commonly occurs in people between the ages of 30 and 60, although children can also develop the condition. People with Down syndrome may be at a higher risk for achalasia.

Diagnosing Achalasia

Diagnosing achalasia can be challenging, as the symptoms are similar to those of heartburn. Your doctor may initially treat you for heartburn, but if your symptoms persist, they may recommend additional tests, such as:

• Endoscopy: A thin, flexible tube with a camera is inserted down your throat to examine your esophagus.

• Barium swallow test: You swallow a barium solution, and X-rays are taken to observe the movement of the barium through your esophagus.

• Manometry: A thin tube is inserted through your nose and into your esophagus to measure the strength of your esophageal muscles and the function of the valve between your esophagus and stomach.

Treatment Options for Achalasia

Surgery

Surgery is the most effective treatment for achalasia, providing long-term relief from symptoms for most people. The two most common surgical procedures are:

1. Heller myotomy: The surgeon makes small incisions in your abdomen and uses surgical tools to cut the tight muscles at the lower end of your esophagus, making swallowing easier.

2. Peroral endoscopic myotomy (POEM): The surgeon inserts an endoscope through your mouth and makes a small cut in the lining of your esophagus to access and cut the tight muscles, improving swallowing.

Both procedures are generally successful, although some people may experience acid reflux after surgery.

Other Treatments

Non-surgical treatment options for achalasia include:

• Botox injections: Botox is injected into the tight esophageal muscles to help them relax temporarily, improving swallowing.

• Pneumatic dilation: A balloon is inserted into the valve between the esophagus and stomach and inflated to stretch the tight muscles. This procedure may need to be repeated several times for optimal results.

• Medication: Nitrates and calcium channel blockers can help relax the lower esophageal sphincter, reducing symptoms.

Your doctor will work with you to determine the best treatment approach based on your individual needs and the severity of your condition.

Living with Achalasia

While there is no special diet for achalasia, you may find that certain foods and drinks are easier to swallow than others. Drinking more water with meals and consuming carbonated beverages like colas may help push food through the esophagus. In severe cases, a liquid diet may be necessary. Be sure to work with your doctor to ensure you're getting the proper nutrients if you're unable to eat solid foods.

Regular check-ups with your doctor are essential, as people with achalasia may have a slightly increased risk of developing esophageal cancer. With proper management and treatment, most people with achalasia can lead normal, healthy lives.

For more information on achalasia and its management, consult your healthcare provider or visit reputable websites such as the National Institute of Diabetes and Digestive and Kidney Diseases.