Achalasia

Achalasia is one of several subtypes of esophageal motor disorders. It is characterized by the absence of muscular contractions in the lower half of the esophagus and by failure of the valve at the bottom of the esophagus to open and let food into the stomach.

Symptoms of Achalasia

Esophageal motor disorders are persistent problems, usually lasting months or years. So, if you experience only a brief episode of symptoms, it is unlikely that you have a true esophageal motility disorder. The main symptoms of motility disorders are difficulty swallowing, regurgitation of food, and pain. Not all people experience all of these symptoms.

People who have achalasia notice difficulty swallowing as the primary symptom, and may ultimately have regurgitation of food as well. Pain is a relatively uncommon symptom of achalasia. People with achalasia experience a progressive difficulty in eating sold food and in drinking liquids that can take years to evolve. They often experience regurgitation and sometimes have spasm-type chest pain. They require much more time than the average person to eat a meal because food traverses the esophagus so slowly. People with achalasia also sometimes lose weight when their condition becomes advanced.

Causes of Achalasia

The reasons that esophageal muscles fail to contract normally in patients with esophageal motor disorders are unknown. It is likely that the reasons for failure of coordinated muscle contractions depend on the type of disorder. In patients with achalasia, there are nerve cells within the muscle layers of the esophagus that appear to degenerate for reasons that are not currently understood. Similar problems have not been identified in patients with other types of motility disorders.

Diagnosing of Achalasia

Endoscopy

People who have difficulty swallowing usually undergo an endoscopy to ensure that cancer is not an underlying cause of the problem. During an endoscopy procedure, you are sedated while the physician passes a small, flexible telescope through the mouth, down the esophagus, and into the stomach. This provides an opportunity to assess the lining and muscular activity of the esophagus and stomach. Motor problems are sometimes suspected if the physician:

X-Ray

Many patients who have a suspected esophageal motility disorder undergo an x-ray of the esophagus. This is done while the patient swallows a thick barium that is visible under x-rays, creating a picture of the lining of the esophagus and stomach. Discoordinated muscular activity within the esophagus can sometimes be seen using this test.

Manometry

One of the best tests to evaluate for achalasia and other esophageal motor disorders is manometry. This test, performed on an outpatient basis, involves passing small tube down the patient's nose and into the stomach. As it is gradually withdrawn, the patient is instructed to swallow sips of water, permitting the technician who performs the test to measure the strength and coordination of contractions of the esophageal muscles.

Treating of Achalasia

Most esophageal motor disorders don't require specific therapy. When symptoms are particularly bothersome, some patients are treated with drugs that relax the muscles of the esophagus, helping to decrease the discoordinated activity. Surgery is sometimes used to cut the muscles that are causing symptoms. In some patients, the discoordinated activity is thought to be due to irritation of the lining of the esophagus by stomach acid, and treatment for acid reflux is used.