Achalasia

Description of the disease

The esophagus is a muscular tube that connects the throat with the stomach through which swallowed food passes. Achalasia is a disease characterized by a motor disorder in which the normal peristalsis of the esophagus disappears (contractions that push food downwards) and the relaxation of the lower esophageal sphincter is impaired (food almost does not enter the stomach).

The incidence of this disease is not particularly high – about 5 cases per 100,000 population. Both men and women can suffer from achalasia, and the onset of the disease can vary – from 25 to 60 years of age (children can also be affected).

Cause of the disease

It is not precisely known why the muscles of the esophagus lose the ability to contract and relax properly. However, it is believed to be related to impaired innervation of the esophageal muscles (disruption of nerve impulses). Disrupted nerve regulation can occur due to genetic predisposition, infectious factors, immunological disorders, or other reasons (not precisely clear).

Symptoms

Main symptoms of achalasia:

Difficulty swallowing,
Regurgitation of undigested food,
Chest pain,
Weight loss.

Diagnosis

The disease is suspected after determining the symptoms. Various instrumental examinations are also performed: X-ray examination using contrast material (where a certain substance is swallowed and X-rays are taken, showing narrowing of the lower part of the esophagus and retention of material in the esophagus – if the disease is advanced); endoscopic examination (where the esophagus is examined internally); esophageal manometry – one of the most accurate diagnostic methods, which determines the frequency of esophageal muscle contractions, their strength, and episodes of relaxation of the lower esophageal sphincter.

Treatment

Treatment for achalasia may involve medication, but it is not very effective. Nitrates, calcium channel blockers, anticholinergics, and other medications are prescribed. More often, endoscopic treatment is used, during which esophageal dilatation, balloon dilation, or injection of botulinum toxin may be performed. Sometimes surgical treatment may be recommended, during which part of the lower sphincter muscle is removed. This improves food passage into the stomach and prevents reflux.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology