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Achalasia
Esophageal achalasia; Swallowing problems - achalasia; Lower esophageal sphincter; LES; Myotomy
The tube that carries food from the mouth to the stomach is the esophagus. Achalasia makes it harder for the esophagus to move food into the stomach.
Causes
There is a muscular ring at the point where the esophagus and stomach meet. It is called the lower esophageal sphincter (LES). Normally, this muscle relaxes when you swallow to allow food to pass into the stomach. In people with achalasia, it does not relax as well. In addition, the normal muscle activity of the esophagus (peristalsis) is reduced.
This problem is caused by damage to the nerves of the esophagus.
Other problems can cause similar symptoms, such as cancer of the esophagus or upper stomach, and a parasite infection that causes Chagas disease .
Chagas disease
Chagas disease is an illness spread by insects. The disease is common in South and Central America.
Achalasia is rare. It may occur at any age, but is most common in middle-aged or older adults. In some people, the problem may be inherited.
Symptoms
Symptoms include:
- Backflow (regurgitation) of food
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Chest pain
, which may increase after eating, or may be felt as pain in the back, neck, and arms
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
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- Difficulty swallowing liquids and solids
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Heartburn
Heartburn
Heartburn is a painful burning feeling just below or behind the breastbone. Most of the time it comes from the esophagus. The pain often rises in y...
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Exams and Tests
Physical exam may show signs of anemia or malnutrition .
Anemia
Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to body tissues. Different type...
Malnutrition
Malnutrition is the condition that occurs when your body does not get enough nutrients.
Tests include:
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Manometry
, a test to measure how well the esophagus is working.
Manometry
Esophageal manometry is a test to measure how well the esophagus is working.
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EGD
or upper endoscopy, a test to examine the lining of the stomach and esophagus. It uses a flexible tube and camera.
EGD
Esophagogastroduodenoscopy (EGD) is a test to examine the lining of the esophagus, stomach, and first part of the small intestine.
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Upper GI x-ray
.
Upper GI x-ray
An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test....
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Treatment
The goal of treatment is to reduce the pressure at the sphincter muscle and allow food and liquids to pass easily into the stomach. Therapy may involve:
- Injection with botulinum toxin (Botox). This may help relax the sphincter muscles. However, the benefit wears off within a few weeks or months.
- Medicines, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
- Surgery (called a myotomy). In this procedure, the lower sphincter muscle is cut.
- Widening (dilation) of the esophagus at the location of the narrowing. This is done during EGD.
Your health care provider can help you decide which treatment is best for you.
Outlook (Prognosis)
The outcomes of surgery and non-surgical treatments are similar. More than one treatment is sometimes necessary.
Possible Complications
Complications may include:
- Backflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)
- Breathing food contents into the lungs (aspiration), which can cause pneumonia
- Tearing (perforation) of the esophagus
When to Contact a Medical Professional
Call your provider if:
- You have trouble swallowing or painful swallowing
- Your symptoms continue, even with treatment for achalasia
Prevention
Many of the causes of achalasia cannot be prevented. However, treatment may help to prevent complications.
References
Falk GW, Katzka DA. Diseases of the esophagus In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 138.
Pandolfino JE, Kahrilas PJ. Esophageal neuromuscular function and motility disorders. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease . 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 43.
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Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
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Upper gastrointestinal system - illustration
The upper gastrointestinal organs include the mouth, esophagus and stomach.
Upper gastrointestinal system
illustration
-
Normal anatomy
Presentation
-
Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
-
Upper gastrointestinal system - illustration
The upper gastrointestinal organs include the mouth, esophagus and stomach.
Upper gastrointestinal system
illustration
-
Normal anatomy
Presentation
Review Date: 10/27/2015
Reviewed By: Subodh K. Lal, MD, gastroenterologist at Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
