Achalasia

Causes and Risks:
The disorder is characterized by loss of the wave-like contraction of smooth muscles that forces food through the digestive tract ( peristalsis ). The condition also includes spasms of the valve (sphincter) from the esophagus to the stomach that does not relax and lack of nervous stimulation of the esophagus. Causes include damage to the nerves to the esophagus, parasitic infection, and hereditary factors. Achalasia may occur at any age but increases with frequency with advancing age. The incidence is 2 out of 10,000 people.

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

Symptoms:



Signs and Tests:
Physical examination may show signs of anemia . An upper GI and small bowel series shows absence of peristalsis and narrowing of lower esophagus.

Other tests that may be performed:



Treatment:
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter by special instruments.

Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter. Sometimes, botulinum toxin is injected to relax the sphincter.

Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.

Prognosis:
The effectiveness of treatment varies from 60 to 85%, depending on the procedure.

Complications:

  • tearing (perforation) of the esophagus
  • regurgitation of acid or food from the stomach into the esophagus (reflux)



Call Your Healthcare Provider:
Call for an appointment with your health care provider if persistent difficulty swallowing or painful swallowing develops, or if symptoms persist despite treatment for esophageal achalasia.

Call your health care provider if vomiting blood or other new symptoms develop.


This illustration shows the major organs of the digestive system. Their relative sizes and positioning in the body are also demonstrated.