Achalasia is a disease which affects the esophagus. You may know that the esophagus is a tube-like structure that connects the mouth to the stomach. In achalasia, the esophagus does not function properly and therefore causes uncomfortable symptoms for the affected individual.

Normally, when we swallow food and liquid, the esophagus takes care of transporting the material down to the stomach for digestion. This is not something we normally need to worry about, as the act of swallowing lets the esophagus know it is time to work.

We can only control roughly the first half of the esophagus voluntarily by swallowing. The second half of the esophagus is controlled by the involuntary nervous system (as is the rest of the digestive tract down to the anus).

At the very end of the esophagus, there is a sphincter muscle known as the lower esophageal sphincter (LES for short). The LES is important to prevent the strong acids of the stomach from going backwards up into the esophagus and throat.

esophagus

a muscular tube that in adult humans is about nine inches (23 centimeters) long and passes from the pharynx down the neck between the trachea and the spinal column and behind the left bronchus where it pierces the diaphragm slightly to the left of the middle line and joins the cardiac end of the stomach

Inappropriate relaxation of the LES is actually the cause of heartburn, as stomach acid is allowed to reflux backwards into the esophagus and causes the burning sensation so many of us are familiar with. Normally, the LES will relax only to let food or liquid pass into the stomach. In achalasia, this relaxation does not occur.

In a sense, then, achalasia is almost the opposite of heartburn. In heartburn, the LES relaxes too much, whereas in achalasia, the LES doesnt relax enough. Why achalasia occurs is unknown. It is known, however, that people with achalasia lose some of the nerves that supply the esophagus. The net result is that the normal, smooth waves of muscle contraction that carry food down to the stomach do not occur properly and, as mentioned, the LES fails to relax when it is supposed to.

Achalasia usually first affects people between 25 and 60 years old. The symptoms of achalasia are all related to the malfunctioning esophagus. Difficulty swallowing, usually for solids first and then liquids, is the most common complaint. Patients may also experience re-gurgitation of undigested food and pain or discomfort in the chest. Some may even lose weight because the eating experience can become so uncomfortable.

If your doctor suspects achalasia, there are several tests that may need to be done to confirm the diagnosis. Patients are often first asked to undergo a test called a barium swallow. In this test, a liquid dye is swallowed and then x-rays of the esophagus are taken. This test is easy and painless. The x-ray will show blockage of the esophagus when achalasia is present.

Because tumors can also cause blockage of the esophagus, the next test that usually needs to be done is called endoscopy. This test involves inserting a tube through the mouth and into the esophagus. The tube has a camera on the end of it so the doctor can see the inside of the esophagus directly. While this procedure can sometimes be uncomfortable, it is not painful and usually a sedative is given before starting to make the patient comfortable.

If no tumor is visualized, the final test to confirm the diagnosis is called manometry. This involves placing a small probe through the mouth or nose down into the stomach. Again, while sometimes uncomfortable, this test is not painful and doesnt take long. The patient is asked to swallow several times and pressure readings are taken from inside the esophagus. Finally, the diagnosis can be made!

Treatment can take several forms. Usually, non-surgical treatments are tried first. The most common procedure is balloon dilation. In this procedure, deflated balloons are placed through the mouth into the esophagus.

endoscopy

the process in which an instrument is used for visualizing the interior of a hollow organ (as the rectum or urethra)

Once in position, the balloons are inflated, causing expansion of the esophagus in the affected areas. Usually after 2 or 3 sessions, patients are markedly improved. Another treatment is injections of a muscle paralyzer into the esophagus, which is done via endoscopy. These treatments generally need to be repeated every 6-12 months.

For those who fail these treatments, surgery may be required. The surgery involves cutting through the muscle fibers which wont relax and re-sewing the esophagus back together. Surgery is generally quite successful when required.

Overall, achalasia is a fairly uncommon disease. Those who are affected, however, can suffer greatly before treatment begins. Usually, however, treatment is quite successful and lets people return to a normal-swallowing lifestyle.