Achalasia

Definition

Achalasia is a disorder of the the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach

Alternative Names

Esophageal achalasia

Causes, incidence, and risk factors

The main problem in achalasia is a failure of the a muscular ring where the esophagus and stomach come together (lower esophageal sphincter) to relax during swallowing.

Another part of the disorder is a lack of nerve stimulation to the muscles of the esophagus. Causes include:

• Cancers
• Damage to the nerves of the esophagus
• Infection with a parasite
• Inherited factors

As a result, the wave-like contractions of smooth muscles that normally force food through the esophagus and other parts of the digestive tract do not work as well. (These contractions are called peristalsis.)

Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults.

Symptoms

• Backflow (regurgitation) of food
• Chest pain which may increase after eating or may radiate to the back, neck, and arms
• Cough
• Difficulty swallowing liquids and solids
• Heartburn
• Unintentional weight loss

Signs and tests

Physical examination may show signs of anemia.

Tests include:

• Esophageal manometry
• Upper GI x-ray

Treatment

The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

• Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.
• Medications such as long-acting nitrates or calcium channel blockers, which can be used to lower the pressure at the lower esophagus sphincter.
• Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter.

Your doctor can help you decide which treatment is best for your situation.

Expectations (prognosis)

The outcomes of surgery and non-surgical treatments are similar. Sometimes more than one treatment is necessary.

Complications

• Breathing food contents into the lungs, which can cause pneumonia
• Regurgitation of acid or food from the stomach into the esophagus (reflux)
• Tearing (perforation) of the esophagus

Calling your health care provider

Call your health care provider if you have difficulty swallowing or painful swallowing, or if your symptoms continue despite treatment for achalasia.

Prevention

Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

References

Goldman L, Ausiello DA. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007.