Achalasia: Causes, Risk Factors, Types, Symptoms, Prevention, Diagnosis & Evaluation, Treatment & Management, and When to Consult a Physician

Overview Types Causes & Risk Factors Symptoms Preventions Treatment

Overview

Achalasia is a rare esophageal motility disorder that affects the ability of the lower esophageal sphincter (LES) to relax and allow food to pass into the stomach. This comprehensive article provides an in-depth look at achalasia, including its causes, types, symptoms, diagnosis and evaluation, treatment and management options, and guidance on when to seek medical attention.

Types of Achalasia

There are several types of achalasia, including:

1) Classic Achalasia: This is the most common type, characterized by a failure of the LES to relax and difficulty in moving food into the stomach.

2) Variant Achalasia: This type involves additional abnormalities in the esophagus, such as esophageal spasms or contractions.

3) Spastic Achalasia: In spastic achalasia, there is excessive muscle contractions in the esophagus, causing symptoms similar to classic achalasia.

Causes of Achalasia

The exact cause of achalasia is not well understood, but several factors may contribute to its development. Possible causes and risk factors include:

Autoimmune Response: Some researchers believe that an autoimmune response may lead to the destruction of the nerve cells in the esophagus responsible for muscle relaxation.
Genetic Predisposition: There may be a genetic component to achalasia, as it can run in families.
Viral Infections: Viral infections, although rare, have been associated with the onset of achalasia.

Symptoms of Achalasia

Achalasia can cause a range of symptoms that may worsen over time. Common symptoms include:

1. Dysphagia: Difficulty swallowing both solids and liquids, often leading to regurgitation of undigested food.

2. Regurgitation: Food and liquids that do not pass into the stomach can regurgitate into the throat or mouth.

3. Chest Pain or Discomfort: Some individuals experience chest pain or discomfort, particularly during or after eating.

4. HeartBurning: Achalasia can sometimes cause symptoms similar to gastroesophageal reflux disease (GERD), including heartburn.

5. Weight Loss: Persistent difficulty swallowing can lead to unintended weight loss.

6. Coughing and Aspiration: Aspiration of regurgitated food or liquids into the lungs can lead to coughing, pneumonia, or lung infections.

Preventions of Achalasia

Unfortunately, there is no known way to prevent achalasia.

Diagnosis of Achalasia

Diagnosing achalasia involves several tests and evaluations, including:

Barium Swallow: This imaging test involves swallowing a barium solution to visualize the esophagus's shape and function.
Esophageal Manometry: A thin tube is inserted into the esophagus to measure pressure and assess how well the LES relaxes.
Endoscopy: A flexible tube with a camera is used to examine the esophagus and rule out other conditions.

Treatment for Achalasia

The goal of achalasia treatment is to relieve symptoms and improve esophageal function. Treatment options include:

Oral Medications: Medications that relax the LES, such as calcium channel blockers or nitrates, may provide temporary relief.
Botox Injections: Injecting botulinum toxin into the LES can help relax the muscle temporarily.
Dilation: Esophageal dilation, using a balloon or bougie, can stretch and widen the LES to allow easier food passage.
Surgery: Surgical options, such as Heller myotomy, involve cutting the muscle of the LES to improve its function.
Peroral Endoscopic Myotomy (POEM): A less invasive procedure, POEM involves making small incisions in the esophagus and performing a myotomy to relax the LES.

When to seek medical attention ?

It's crucial to seek medical attention if you experience symptoms of achalasia, especially if they interfere with your ability to eat and lead to weight loss. Additionally, consult a healthcare provider if you have a history of achalasia and your symptoms worsen or change. Early diagnosis and appropriate treatment can help manage the condition and prevent complications.