Achalasia

Achalasia is a disorder of the esophagus, the tube that carries food from the mouth to the stomach. This condition affects the ability of the esophagus to move food into the stomach.

Causes

There is a muscular ring at the point where the esophagus and stomach meet, called the lower esophageal sphincter. Normally, this muscle relaxes when you swallow. 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.

Achalasia is rare. It may occur at any age, but is most common in middle-aged or older adults. The problem may be inherited in some people.

Symptoms

• Backflow (regurgitation) of food
• Chest pain, which may increase after eating or may be felt in the back, neck, and arms
• Cough
• Difficulty swallowing liquids and solids
• Heartburn
• Unintentional weight loss
• Exams and Tests
• Physical exam may show signs of anemia or malnutrition.

Tests

• Esophageal manometry
• Esophagogastroduodenoscopy
• Upper GI X-ray

Treatment

The goal of 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. However, the benefit wears off within a few weeks or months.
• Medications, such as long-acting nitrates or calcium channel blockers. These drugs can be used to relax the lower esophagus sphincter.
• Surgery (called an esophagomyotomy). This procedure may be needed to decrease the pressure in the lower sphincter.
• Widening (dilation) of the esophagus at the location of the narrowing. This is done during esophagogastroduodenoscopy.

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