Achalasia

Achalasia is a disorder making it difficult for food and liquid to pass through the stomach. The muscular valve between the food tube and the stomach is not relaxed, resulting in food backing up into the esophagus.

It is a rare disorder and is most commonly seen among middle-aged and older adults.

As the condition progresses, people with achalasia may find it more and more difficult in swallowing solid food, leading to severe malnutrition and weight loss.

If diagnosed at an early stage, achalasia can be successfully treated with minimally invasive surgical procedures.

Difficulty in swallowing food is the most common symptom of Achalasia. Other noticeable symptoms include:

• Regurgitation or backing up of food into the food tube
• Discomfort or pain in the chest due to retained food in the esophagus. Pain often increases after eating. Pain and discomfort may also be felt in the arms, back, and neck.
• Heartburn which is not relieved with normal heartburn medications
• Weight loss
• Cough

If regurgitation happens in the night, there are chances that food may be aspirated into the lungs. This is a serious medical condition.

The main causes of Achalasia are:

• Inability of muscles in the esophagus to squeeze food down
• Inability of the valve at the end of the esophagus to relax, making it difficult for food to pass through the stomach

This is caused by degeneration of the nerves in the esophagus. In early stages of the disease, degeneration of nerves affects the valve of food tube.

With the progress of the disease, muscles of food tube also degenerate affecting the movement of the food through the tube. After a period of time the food tube stretches and dilates.

Making a diagnosis of Achalasia is done by several procedures, which include:

• Video-Esophagram – in this procedure, an x-ray image of the esophagus is taken after having barium. This helps to track the movement of barium into the stomach and also dilation of esophagus, if any.
• Esophageal manometry – this procedure is used to identify the abnormalities in the muscles of the esophagus. It also tracks the failure of the food valve while swallowing food.
• Endoscopy – this is one of the most common methods for the diagnosis of achalasia. With this method, a small fiberoptic tube with a camera at one end is swallowed. This helps to visualize the inside of the esophagus.As the pressure in the valve at the opening to the stomach is more, the movement of the tube may be hindered.This method will also help to distinguish achalasia from other conditions like esophageal cancer and Chagas’ disease.

History of the person often reveals an inability to swallow food. In many cases, the patient compensates his/her inability to swallow food by eating slowly, and this may delay diagnosis of the condition. 

Treatment for achalasia focuses on reducing the pressure at the sphincter valve of the esophagus, allowing the food to pass through easily.

Non-surgical treatments:

• Oral medications, dilation of esophageal sphincter, surgery, and Botox injections are used to treat achalasia.
• Oral medications like nifedipine, isosorbide dinitrate, calcium channel blockers and verapamil, are used for short-term relief of the symptoms. These drugs help to relax the valve at the opening of esophagus.
• Botox injections is a non-surgical method most commonly used in elderly patients. This helps to weaken the valve and to help improve eating. Effects of Botox wear off within few months and the patient may need to go for a repeat injection.
• Forceful dilation of the lower part of the esophagus with a balloon is another treatment option for the condition. The balloon is placed near the valve with the help of x-ray and then expanded to dilate the region.

Surgical treatment:

In surgical treatment, the valve of esophagus is cut which helps in easy passage of food. This is done laparoscopically through a small incision in the abdominal region.

There are several alternative and homeopathic remedies used for Achalasia.

Arsenic album and baptisia are homeopathic remedies used to control heartburn and regurgitation.

Ignatia is used to make swallowing food easier. Asafoetida helps to control the movement of food in the esophagus and to prevent backing up.

Magnesium citrate is used to relax the esophagus. Drinking high quality nutrients and taking flax oil are also used as alternative treatment methods.

There are different ways to adapt your lifestyle in coping with Achalasia and it can be successfully treated, if detected early. In some cases, multiple treatment may be needed.

Dietary modifications for well-balanced nutrition is very important. Diet can be individualized by adjusting the speed of ingesting food, based on difficulty in swallowing.

Stress management is also equally important in coping with the symptoms of this disorder.

There are several risk groups and complications of achalasia.

Achalasia is more commonly found in people above 30 years old, though in rare cases it may occur in children.

This condition is also found to be more common among people with autoimmune disorders.

Some of the possible complications of achalasia include back flow of food into the esophagus from the stomach, breathing food contents into the lungs, and tearing of the esophagus.