Difficulty in swallowing due to a muscle disorder of the oesophagus
In people with achalasia, the passage of food and drink into the stomach from the oesophagus is delayed or prevented. The problem is mainly caused by failure of the lower oesophageal sphincter (the ring of muscle at the lower end of the oesophagus) to relax normally and allow food to pass into the stomach during swallowing. Achalasia may also be caused by poor muscle coordination in the oesophagus. The condition causes the lower part of the oesophagus to be progressively distorted and widened over months or years, and makes swallowing increasingly difficult. Achalasia most commonly occurs in people between the ages of 20 and 40.
Symptoms of achalasia usually develop slowly and include the following:
Difficulty in swallowing.
Chest pain or a feeling of discomfort behind the breastbone, which may be related to eating.
Regurgitating undigested food during meals or some hours afterwards, especially at night.
Eventually, weight loss.
If achalasia is left untreated, there is a slightly increased risk of developing cancer of the oesophagus.
If your doctor suspects that you have achalasia, a chest X-ray may be arranged to look for the typical widening and distortion of the oesophagus. The diagnosis may be apparent from a barium swallow. Your doctor may look down your oesophagus using a flexible viewing instrument called an endoscope (see Endoscopy) to confirm the diagnosis and eliminate other possible disorders, such as cancer of the oesophagus. Oesophageal manometry is considered the most reliable indicator of achalasia. In this procedure, a flexible tube is passed down the oesophagus in order to measure pressures. Normally, the procedure shows changing pressures as a result of the alternate contractions and relaxations of the oesophageal muscles. In achalasia, these pressure changes are absent, and the overall pressure is high due to incomplete muscle relaxation.
Several different effective treatments are available for achalasia. The choice of treatment depends on your age and general health in addition to the severity and duration of your symptoms.
The simplest treatment is for your doctor to prescribe drugs called calcium channel blockers, which temporarily relax the lower oesophageal sphincter muscle. However, for longer-term relief, the treatment most often used is to pass a small balloon down to the oesophageal sphincter. Once the balloon is in place, it is inflated with either air or water to stretch the sphincter and is then removed. This procedure is successful in at least half of all people with the disorder. However, for a few people, it may have to be repeated over periods varying from 6 months to several years.
An alternative treatment is the injection of botulinum toxin into the sphincter. In small doses, the toxin paralyses the affected muscles, causing them to relax and allow food and liquids to pass. This effect typically lasts a little over a year and may need to be repeated.
If none of these methods is successful, laparoscopic surgery may be performed using instruments passed through small incisions in the abdomen. Some of the muscle at the lower end of the oesophagus may be cut to allow food to pass into the stomach. In about 1 in 10 cases, this procedure leads to the stomach contents flowing back up the oesophagus, a condition that will also need treatment (see Gastro-oesophageal reflux disease).
From the 2010 revision of the Complete Home Medical Guide © Dorling Kindersley Limited.