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Achalasia

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WHAT IS ACHALASIA?
The esophagus, also known as the "swallowing tube" is located just below the throat. In a normal esophagus, there is a relaxation process that occurs which allows food to pass into the stomach once it has been chewed.
Achalasia is a rare disease of the lower portion of the muscle of the esophagus. (MedicineNet.com http://www.medicinenet.com/achalasia/article.htm)

The lower portion of the esophagus is what relaxes in order for food to pass into the stomach. When this doesn't occur, it is known as a "failure to relax" which is the definition of achalasia.

In a healthily functioning esophagus, three functional parts work together to achieve swallowing. Like other systems in our bodies, there is a wave function which is known as the peristaltic wave, which allows parts of the "tube" to remain closed off while others relax and open up. The three functioning parts of the esophagus operate in this way, with the top part remaining closed off until food is ready to be swallowed, then opening up while the bottom two remain closed. As the food travels down, the middle, then the bottom open up, while the top closes off. It is this bottom portion that fails to relax or open up in achalasia, making the last part of swallowing difficult.

CAUSES
At this time, there is no known cause of achalasia. Genes may play a role but this has yet to be determined.
Symptoms of achalasia include a feeling of heaviness in the chest after swallowing, or a feeling of not being able to fully swallow. Occasionally, pain be present and can be severe. It can also mimic heart pain, so it is important to diagnose this condition as soon as possible to avoid feeling that you are having an issue with your heart.

TREATMENTS
Treatments for achalasia include oral medications, dilation or stretching of the lower esophageal sphincter (dilation), surgery to cut the sphincter (esophagomyotomy), and the injection of botulinum toxin (Botox) into the sphincter. All four treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach.

Esophagomyotomy
The sphincter can be cut surgically via a procedure called esophagomyotomy. The surgery can be done using a large abdominal incision or laparoscopically through small punctures in the abdomen. In general, the laparoscopic approach is used with uncomplicated achalasia. Alternatively, the surgery can be done with a large incision or laparoscopically through the chest. Esophagomyotomy is more successful than forceful dilation, probably because the pressure in the lower sphincter is reduced to a greater extent and more reliably; 80-90% of patients have good results. With prolonged follow-up, however, some patients develop recurrent dysphagia. Thus, esophagomyotomy does not guarantee a permanent cure. The most important side effect from the more reliable and greater reduction in pressure with esophagomyotomy, is reflux of acid (gastroesophageal reflux disease or GERD). In order to prevent this, the esophagomyotomy may be modified so that it doesn't completely cut the sphincter or the esophagomyotomy may be combined with anti-reflux surgery (fundoplication). Whichever surgical procedure is done, some physicians recommend life-long treatment with oral medications for acid reflux. Others recommend 24 hour esophageal acid testing with lifelong medication only if acid reflux is found.

Botulinum toxin
A newer, and less invasive treatment for achalasia is the endoscopic injection of botulinum toxin into the lower sphincter to weaken it. These injections require no hospitalization and are done on an outpatient basis.Treatment with botulinum toxin is safe, but the effects on the sphincter often last only for months, and additional injections with botulinum toxin may be necessary. Injection is a good option for patients who are very elderly or are at high risk for surgery, e.g., patients with severe heart or lung disease. It also allows patients who have lost substantial weight to eat and improve their nutritional status prior to "permanent" treatment with surgery. This may reduce post-surgical complications.

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Aimee Boyle
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.