Patient's Complete Guide to Achalasia

Overview of Achalasia

Achalasia( ایک بیماری جِس میں غَذا مَعمُول کے مُطابَق معدَہ میں نَہیں پُہَنچتی گو کہ کوئی رُکاوَٹ ظَاہَر نَہیں ہوتی) is a rare disorder in which the esophageal muscles fail to relax. This failure leads to difficulty in swallowing the food. The esophagus is a small tube made up of muscles that are responsible for the transport of food from your mouth to your stomach. This esophagus meets with the stomach at a point where there is a ring of muscle present. This ring is known as Lower Esophageal Sphincter (LES). The relaxation of this muscle is inevitable for the entrance of food into the stomach. When the food has entered, this muscle contracts so that the food cannot move back up. In the case of achalasia, this muscle does not relax and this disrupts the entrance of food into the stomach. 

Occurrence of Achalasia 

Achalasia is a rare swallowing disorder that occurs in about 1 in every 100,000 people worldwide. The most common occurrence of this disease is in the age group of 25-60 years old.  Achalasia can also affect children as well. Although the ratio of this disease is uncommon in children under the age group of 16. It equally affects all age groups. Achalasia equally affects all genders.

Signs and Symptoms of Achalasia

The symptoms for achalasia are slow in progression. They may develop slowly at the start but the signs may last for months or years. Some of the most common symptoms are

  1. Difficulty in swallowing
  2. Backing up of swallowed food (regurgitation)
  3. Occasional pain in the chest
  4. Heartburn
  5. Nighttime coughing
  6. Weight loss (late symptom)
  7. Hiccups (least common symptom)

Causes of Achalasia

The reason why this nervous disorder occurs is still unknown. But the doctors and healthcare providers do suspect a loss of nerve cells in the esophageal region. In very rare cases, achalasia can also be caused due to tumours.

Risk Factors of Achalasia

The risk factors for achalasia are as follows:

  • Allgrove Syndrome

It is a rare autosomal recessive disease that is characterized by three specific conditions such as achalasia, alacrima, and Addison disease. People that suffer from AAA syndrome tend to sweat a lot, have difficulty in regulating blood pressure, and maintaining their body temperatures.

  • Measles Infection

Measles is a contagious disease. It is a disease that mainly affects respiratory infection. Main symptoms include total body rash and flu. Measles can be a contributing factor to achalasia.

  • Herpes Infection

Herpes is an infection that is caused by a virus. Herpes can appear on several body parts. The most common occurrences of herpes are on the genitals and mouth.

Achalasia Complications

The complications for achalasia are as follows:

  • Aspiration Pneumonia

When the food or liquid is backed up, it can go into the patient’s lungs. This condition can cause breathing difficulty in the patient.

  • Esophageal Perforation

When the muscles of the esophagus become weak. This can lead to the formation of a hole in the esophagus. Sometimes treatments can also lead to esophageal perforations. This condition can cause life-threatening infections to the affected person.

  • Esophageal Cancer

The risk of developing cancer is relatively high with the onset of achalasia.

Prevention

Since it is a nervous disorder the preventive measure cannot be concrete. But some simple activities may help the body to fight more actively against the consequences.

  • Swallowing Therapy

This is a simple therapeutic technique. In this procedure, a speech therapist helps the patients to adopt certain strategies that will help them in swallowing the food better.

  • Swallowing Exercises

These exercises are helpful to improve the strength and movement of the lower esophagus.

  • Improved Dietary Choices

A slight change in the eating habits such as the addition of a softer diet can prevent the onset of this disorder. People should keep a check on their eating habits and should make sure that they are not skipping meals.

  • Hydration

Dehydration can cause a number of issues to your body. Loss of water can constrict your esophagus. Therefore, make sure to stay hydrated.

Diagnosis

Your doctor will ask you basic questions about the symptoms and your medical history. In addition to physical tests, the doctor may recommend the following tests

  • Endoscopy

 A long, thin, and flexible tube is passed through the mouth of the patient. This tube has both light and a camera that gives a visual of the affected esophagus.

  • Esophagram

It is an x-ray exam that is specifically for the esophagus. The patient drinks a liquid of barium sulfate or a tablet. The radiologist will then look for the signs and symptoms of achalasia in the patient. The most common signs that a radiologist looks for are:

  • Widening of the esophagus 
  • Incomplete emptying 
  • The tight lower esophageal sphincter
  • Manometry

Manometry is a method in which the pressure difference is noted in the esophagus. The rhythmic muscle movement gives an indication of the status of the patient’s esophagus.

 

Treatment of Achalasia | When to Consult a Doctor

At present, there is no known cure for the treatment of achalasia. However certain treatments can slow down the progression of the disease. The treatments that are in practice are there either to ease the opening of LES or to prevent complications.

Some of the treatments for achalasia are as follows:

  • Pneumatic Dilation

It is an endoscopic method for the treatment of achalasia. A balloon is inserted inside the patient. This balloon is then inflated using an x-ray guide to relieve the muscles of the esophagus. The patients may need more than one procedure to get relief from pain.

  • Botulinum Toxin Injection

These injections are mainly administered to block the nerve signal to the muscle.  Most of the time these injections are used to get rid of wrinkles. But they are also majorly used for the treatment of achalasia. When they are injected inside the LES, they aid in relaxing the constricted muscles. The patient is mostly under the influence of anesthesia. The patients may have to repeat the procedure after 3 to 12 weeks because the benefits may start to wear off.

  • Surgery

The procedure in which the LES of the patient is opened is called myotomy. A minimally invasive approach in myotomy is laparoscopy. With the help of small incisions, a tube is inserted. This laparoscopy gives the doctor a live visual of the inside. The doctor also maintains the acid reflux at the time of the surgical procedure. This surgical procedure tends to give the patients long-term relief from the discomfort.

  • Peroral Endoscopic Myotomy (POEM)

POEM is a relatively new endoscopic procedure for the treatment of achalasia.  With the help of small cuts, a tube is inserted into the esophagus. Some part of the muscle layer is removed. This step helps to decrease the tightness of LES. This procedure then helps the food to move more easily. The recovery from POEM is rapid.

  • Medicines

Doctors may also prescribe some oral medicines to their patients for the treatment of achalasia. These medications help to relax the movement of the lower esophageal sphincter. Nitrates are the most common drugs. Some of the commonly prescribed medicines are:

  • Isordil 
  • Calcium Channel Blockers (CCBs)

Note:  (Consult your doctor before taking any medications)

Speciality for Achalasia

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