Esophageal achalasia is a rare disorder affecting the motility of esophagus. In this condition the muscles of esophagus and esophageal sphincter do not work properly due to damage to the nerve cells. Hence the food and liquid that is swallowed does not squeeze down into the stomach. This leads to difficulty in swallowing, backup and vomiting of food. Chest pain, weight loss, and coughing are other encountered symptoms.
In majority of cases the reason for esophageal achalasia is not known.
Causes And Risk Factors Of Esophageal Achalasia
Esophagus is a connecting tube between mouth and stomach. Normally people know it as food pipe. The food and liquid that we consume passes through esophagus and reaches the stomach. The muscles of esophagus wall contracts in rhythm to facilitate the food to enter into the stomach.
However, in esophageal achalasia the sphincter fails to relax completely and the movement of smooth muscles of esophagus is obliterated. Both this factors makes food difficult to pass in stomach leading to backup and vomiting. Achalasia can occur in both males and females equally. It can develop at any age but it is usually observed among people between third and fifth decade of life.
The exact cause for its occurrence is not fully understood. The precipitating factors can be:
- Damage or degeneration of nerve that innervates the esophageal muscles.
- Other conditions such as gastric cancer infiltrating the esophagus, Chagas disease, irradiation, certain drugs and toxins can also lead to achalasia. Chagas disease is rare parasitic infection which has its predominance in African countries.
- People with autoimmune disease.
Symptoms Of Esophageal Achalasia
Difficulty in swallowing, pain in chest and regurgitation of food are the main symptoms of esophageal achalasia. In the beginning patient has mild sensation of food sticking in the middle of chest (epigastrium). Gradually patient experiences difficulty in swallowing fluid compared to solid food. However, over a period of time patient will start experiencing difficulty in swallowing food.
The food or liquid consumed regurgitates out soon after eating. It is accompanied with chest pain and heartburn. As patient is not able to eat properly he suffers from weight loss. Patient also experiences violent coughing especially while lying down. He also feels sensation of lump in throat. The symptoms progressively become worse.
Diagnosis Of Esophageal Achalasia
Since achalasia is rare disorder it is often misdiagnosed with other common digestive disorders having similar symptoms. To diagnose esophageal achalasia parameters must be included such as clinical symptoms, radiography, endoscopy and esophageal manometry.
- Esophageal manometry is helps in definite diagnosis of esophageal achalasia. It is a test that measures rhythmic contraction of muscles of esophagus when a person swallows. Absence of proper rhythmic movement and esophageal sphincter relaxation is suggestive of achlasia.
- Barium X-ray is another important imaging technique that helps to detect the blockage of esophagus.
- Endoscopy helps in examination of inside of the esophagus and stomach. With endoscopy the doctor is able to collect sample of tissue biopsy. It also helps to exclude causes of secondary achlasia such as gastric cancer.
Treatment Options For Esophageal Achalasia
Esophageal achalasia cannot be cured but with treatment the symptoms can be very well managed. The three treatment options are as follows:
- Medications: Medications are beneficial if the diagnosis of disease is made early. Medications used are smooth muscle relaxants which help to relax lower esophageal sphincter. Medicines used are calcium channel blockers and nitrates. In short term medicines may show improvement in symptoms but in long term they may not prove efficient.
- Balloon dilatation: Balloon dilatation is the best non operative therapy which is simple and quick. The procedure includes insertion of a balloon in the narrowed section of the esophagus. Once the balloon reaches the narrow section, it is inflated so that the space becomes wide. It tears some amount of muscles in the esophageal sphincter. Some patients may require one or two repetitions after one or two years.
- Surgery: Surgery is beneficial if the two methods fail. The surgery is called Heller myotomy. In this procedure the surgeon cuts the muscle fiber of lower end of esophageal sphincter. This allows easy passage of food and fluid once the procedure is performed.