Achalasia Symptoms, Diagnosis & Treatment

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Achalasia is a disease of Esophagus (gullet). The lower end of esophagus has a sphincter called as Lower Esophageal Sphincter (LES) which has neuronal innervation. Normally the LES is contracted and prevents the gastric acid reflux into the esophagus, during swallowing  these inhibitory neurons gets a signal and causes relaxation of LES thus allowing the food to pass. In Achalasia the inhibitory neurons that relaxes the LES is lost and the lower end of esophagus does not open up even during swallowing thus causing difficulty in swallowing.

Causes of Achalasia

Most of the time cause of achalasia is unknown also known as Ideopathic. Known causes of achalasia which is a very small number can be due to following reasons or diseases

  • Gastric Carcinoma
  • Lymphoma
  • Chagas Disease
Signs & Symptoms of Achalasia

  • Difficulty in swallowing foods which is progressive for solids and liquids both
  • Regurgitation of undigested food several hours after eating.
  • Weight loss might be present

Achalasia might be associated with weight loss but has no relationship with alcohol or smoking unlike Esophageal cancer which has progressive dysphagia to solids then to liquids and more common in elderly people.

Diagnosis of Achalasia

Barium esophagography is very useful in diagnosing achalasia. Barium esophagography shows dilated esophagus the narrows towards the distal end also known as classic "Bird's Beak Appearance".

Chest X-Ray is useful as well which might show an air fluid level in dilated esophagus, but X-ray is most of the time inconclusive or inaccurate.

Esophageal Manometry is by far the most accurate test to diagnose achalasia. Manometry measures the muscle tone pressure at different stages of swallowing. In achalasia monometry will show increased LES resting pressure

Esophagogastrodudenoscopy (EGD): This test is only done in the presence of alarming symptoms which might point towards a cancer like gastric carcinoma. The alarm symptoms usually consists of following:

  • Anemia
  • Blood or occult blood in stools
  • Weight Loss
  • Onset at elderly age (60 years or more)
  • More than 6 months duration of symptoms
Treatment Of Achalasia

The treatment of Achalasia revolves around three modalities

Pneumatic Dilation: It is the best initial therapy. It is effective in alomost all the patients with a 5% risk of perforation

Botulinum Toxin: It is a toxin produced by a bacteria which causes relaxation or temporary paralysis of LES thus opening up the sphincter. It is usually done when a patient denies pneumatic dilation or if the pneumatic dilation procedure has failed to give relief to the patient. The biggest drawback of this mode of treatment is that it is temporary. Half of the need an injection after 9 months while it is almost certain that all of them will need another injection after 2 years. This method is also used in those individuals who are poor candidates for surgery having several diseases or very old.

Surgical Treatment: Laproscopic Surgical myotomy is reserved only for those on which pneumatic dilation and botulinum toxin does not work. The major complication of this surgery is Gastric Acid Refulx in about 20% of the cases.