Achalasia

 Achalasia is a rare swallowing disorder that affects only 1 in every 100,000 people. Most people are diagnosed between the ages of 25 and 60 years.

CAUSE

The specific cause of achalasia is unknown. However, patients with achalasia have two problems in the esophagus .

The first is that the lower two-thirds of the esophagus does not propel food toward the stomach properly.

The second problem is in the lower esophageal sphincter (LES). The LES normally helps prevent food from flowing backwards, from the stomach into the esophagus. The LES should relax in response to swallowing to allow food to enter the stomach. In patients with achalasia, the LES fails to relax, creating a barrier that prevents food and liquids from passing into the stomach.

Damage to the LES and esophagus causes large volumes of food and saliva to accumulate in the esophagus. Patients can initially compensate for this but eventually the barrier progresses to the point where food and saliva cannot reliably enter the stomach, and, as a result, build up in the esophagus.

SYMPTOMS

 The major symptom is difficulty swallowing (liquids or solids). Other symptoms include chest pain, regurgitation of swallowed food and liquid, heartburn, difficulty burping, a sensation of fullness or a lump in the throat, hiccups, and weight loss.

 DIAGNOSIS

Achalasia is usually suspected based upon the presence of the symptoms described above, but tests such as Chest x-rays, Barium swallow test, Manometry and Endoscopy are needed to confirm the diagnosis.

 TREATMENT

 several options are available for the treatment of achalasia. Unfortunately, none can halt or reverse the underlying problem. However, all of the treatments are effective for improving symptoms. We have 4 ways to treat achalasia :

 drug therapy

 botulinum toxin injection

 balloon dilatation

 surgery

 Two of these treatments (drug therapy and botulinum toxin injection) work by reducing the LES pressure while two other treatments (balloon dilatation and surgery) work by mechanically weakening the muscle fibers of the LES.

RISK OF ESOPHAGEAL CANCER

People with achalasia have an increased risk of esophageal cancer, particularly if obstruction is not adequately relieved. As a result, doctors recommend regular endoscopic screening for early detection of this cancer.