Achalasia is an esophageal disorder that prevents the esophagus from emptying properly. In patients with Achalasia, certain nerve fibers in the esophagus are destroyed. This results in two issues: the esophagus loses its ability to push, and the valve at the lower end of the esophagus (otherwise known as the lower esophageal sphincter) does not relax properly. Achalasia is, in many ways, the opposite condition of GERD. While patients with GERD suffer from a weakened lower esophageal sphincter, patients with Achalasia have an overly tight lower esophageal sphincter.
Like GERD, Achalasia can occur at any age, but is more prominent in middle-aged and elderly individuals. It affects men and women equally, and has not yet been linked to any specific causes.
Diagnosis of achalasia
There are two primary tests used to diagnose Achalasia in patients.
A barium swallow or cine esophagram is performed to evaluate the degree of esophageal distention and extent of narrowing of the LES.
An esophageal motility study (HRIM) is also typically required to make an achalasia diagnosis. These are key in determining which subtype of achalasia the patient has, which plays a large role in the treatment offered to combat the disorder.
Symptoms of Achalasia
People who suffer from Achalasia may experience any number of symptoms, but the most common symptoms include:
• Dysphagia (difficulty swallowing)
• Chest pain
treatments for achalasia
There are many treatment options available to help minimize the effects of achalasia, but achalasia is a lifelong disorder, and currently there is no permanent cure for the disorder. Most treatment is designed to improve the quality of life in patients as much as possible, but no interventions will be able to completely restore the motility of the esophagus to what it should be.
There are a few medications available that are designed to help relax the LES, but most are fairly ineffective. Medications for achalasia often don't work well, and would need to be taken for life.
Although fairly uncommon, botox can be used for temporary relief of achalasia. Botox is injected into the valve between the stomach and esophagus, relaxing the LES. Botox generally results in short term improvement for patients with achalasia, but the long-term results of botox as a treatment method are incredibly poor.
Balloon dilation is currently considered the best nonsurgical option for achalasia, and should be considered for patients that may not be candidates for surgery. During an endoscopy, a balloon is placed through the mouth and down to the valve between the esophagus and stomach. The balloon is then inflated, tearing the muscles in the valve and effectively weakening it. Patients undergoing a balloon dilation do run the risk of tearing the esophagus during the procedure, an error that would need to be fixed surgically, but the risk is minimal. Balloon dilations are not as effective at providing long term relief as surgery, but generally provide achalasia relief and improvement in swallowing for a decent amount of time.
The surgery used to treat achalasia is the Heller myotomy, a laparoscopic procedure that involves cutting the muscle of the LES to relieve dysphagia and allow food to pass through. During the procedure, the LES is then partially rebuilt to prevent reflux from occurring post-surgery. Surgery has proven to be the most successful longterm treatment method for achalasia, and most patients notice improvement in swallowing almost immediately.
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