Achalasia is a disorder that affects your esophagus. This is the swallowing tube that
connects the back of your throat to your stomach. If you have achalasia, your esophagus
does not sufficiently push food or liquid into your stomach. In addition, the ring
of muscle that circles the lower portion of your esophagus does not relax enough to
let food and liquid pass through easily. In fact, achalasia means "failure to relax."
Achalasia usually develops slowly, making it harder for you to swallow food and beverages.
It's caused by loss of the nerve cells that control the swallowing muscles in the
esophagus. Why these nerve cells degenerate, however, isn’t known. Although achalasia
has no cure, symptoms can be controlled with treatment. In rare situations, achalasia
results from a tumor.
Symptoms of achalasia develop gradually. As the esophagus becomes wider and weaker,
you may have these symptoms:
Difficulty swallowing food, a condition called dysphagia
Food or liquid flowing back up into your throat, or regurgitation
Waking up at night from coughing or choking because of regurgitation
Chest pain or pressure
Difficulty burping or hiccups
Achalasia can develop at any age, but it happens most often between ages 30 and 60.
Men and women are equally at risk. Scientists don’t know exactly why this loss of
muscle control in the lower esophagus happens, but risk factors may include:
If your healthcare provider suspects achalasia from your symptoms, he or she may order
three tests to confirm your diagnosis:
Endoscopy. This is an outpatient procedure during which a flexible telescope is passed through
your mouth to examine your esophagus and the valve that opens into your stomach. This
valve is called the lower esophageal sphincter (LES).
Esophogram. This is a special type of X-ray that takes pictures of your esophagus while you swallow
a thick contrast material called barium. Signs of achalasia that the radiologist looks
for are widening of the esophagus, incomplete emptying, and tightness of your LES.
Manometry. This is an outpatient procedure during which a pressure-measuring tube is passed
through your nose into your esophagus. Pressure measurements are taken as you swallow
sips of water. This test may show weak and uncoordinated muscle contractions and pressure
buildup at your LES.
No treatment can restore normal esophageal movement. What treatments can do is help
relieve your symptoms, open up your LES to improve emptying of your esophagus, and
prevent complications. You may also need repeat treatments.
These are common treatments:
Pneumatic dilation. This is an outpatient procedure done under anesthesia. While your healthcare provider
looks into your esophagus through an endoscope, an air-filled balloon is passed through
the valve between the esophagus and stomach and then inflated. You may need more than
one treatment to get relief.
Botox injection. Botox is a medicine that can paralyze muscles. Botox can be injected into the muscles
that control your LES to relax the valve opening. This procedure is also done during
endoscopy. You may be asleep or partially asleep (conscious or "twilight" sedation
through an IV). The results usually wear off in 3 months to one year, so the procedure
almost always needs to be repeated.
Surgery. Surgery to open your LES is called myotomy. During myotomy, the muscles of that valve
are cut. This type of surgery usually provides long-term relief from achalasia symptoms.
Medicines. Two commonly used medicines to treat achalasia are calcium channel blockers and long-acting
nitrates. These medicines are used if surgery is not a choice and symptoms continue
even with Botox injections.
Although you can’t prevent achalasia, treatment can prevent long-term complications.
Possible complications include:
Aspiration pneumonia. This type of pneumonia may be caused when food or liquids in your esophagus back up
into your throat and you breathe them into your lungs.
Esophageal perforation. This complication may happen if the walls of your esophagus become weak and distended.
Perforation may also happen during treatment. Esophageal perforation may cause a life-threatening
Esophageal cancer. People with achalasia are at higher risk for esophageal cancer.
When to call the healthcare provider
Call your healthcare provider if you have any questions about your medicines or treatment.
Let your healthcare provider know right away if you have any of these symptoms:
Increased difficulty swallowing
Worsening regurgitation, especially if you are waking up coughing or choking at night
Symptoms of infection such as chills or fever
Chest pain or difficulty breathing
Living with achalasia
Achalasia is a long-term disease, so it's important to learn as much as you can about
it and work closely with your medical team. Your healthcare providers will need to
follow you on a regular basis, usually once or twice a year, even after symptoms have
been controlled. Keep all your appointments. Your healthcare provider may also want
to repeat endoscopy and an esophogram.
Here are some lifestyle changes that may help you if you have symptoms of dysphagia
Avoid foods or beverages that give you heartburn.
Drink plenty of fluid when eating and chew your food well.
Eat smaller meals more often.
Avoid overeating late at night.
If you have nighttime symptoms, prop up the head of the bed.