Attacking Achalasia

You have difficulty swallowing your food. In fact, it’s very painful. You have a “stuck” feeling like the food is stuck in one place. It feels like you’re going to regurgitate the food. You could have achalasia.

Achalasia combines the Greek words meaning “failure to relax.” It is the narrowing of the esophagus, the swallowing tube.

There can be two separate conditions in achalasia. One is loss of nerve control of normal esophagus-wall muscle behavior. The other is enlargement of the sphincter muscle guarding the stomach entry. In that way, ingested food encounters a double barrier to normal passage.

Achalasia patients complain of upper chest fullness and great pain on swallowing—even fluids. In severe cases, nutrition becomes an immediate concern.

According to the Cleveland Clinic, symptoms of achalasia are:

·       Trouble swallowing (dysphagia), a common early symptom.

·       Regurgitation of undigested food.

·       Chest pain that comes and goes, pain can be severe.

·       Heartburn.

·       Cough at night.

·       Weight loss/malnutrition from difficulty eating, a late symptom.

·       Hiccups, difficulty belching (less common symptoms).

Some complications of achalasia are the result of food backing up (regurgitating) into your esophagus and then drawn into (aspirated) your trachea (windpipe), which leads to your lungs. These complications include pneumonia and lung infections (pulmonary infections). Another complication may be esophageal cancer—having achalasia increases your risk of this cancer.

You can confirm the presence of achalasia with X-rays taken after you swallow a chalky liquid called “barium contrast.” The barium swallow will show a contracting of the esophagus at the lower esophageal sphincter (LES).

Other tests used to diagnose achalasia are upper endoscopy and a manometry. With an upper endoscopy, a flexible, narrow tube with a camera on it—called an endoscope—is passed down your esophagus. The camera then shows images of the inside of your esophagus onto a screen for evaluation. This test helps rule out cancerous (malignant) injuries as well as assess for achalasia.

With manometry, this test measures the timing and vigor of your esophageal muscle contractions and loosening of the lower esophageal sphincter. Failure of the LES to loosen in response to swallowing and lack of muscle compressions along the walls of the esophagus is a positive test for achalasia.

Achalasia is treated with nonsurgical options (balloon dilation, medications and botulinum toxin injection) and surgical options. The goal of treatment is to relieve symptoms by relieving your LES.

Surgery can be the solution to the problem. The surgeon cuts the lower esophageal muscles so food no longer gets hung up there. Some surgeons operate through small incisions, using a scope and instruments passed through the tiny skin openings. Convalescence is short.

If you prefer not going the surgical route, there are the heart medicines, Isordil and Procardia, which relax the esophagus, allowing food to pass with greater ease. The lower part of the esophagus can be dilated with balloons, opening a passage. Botox, a material made from the food poisoning germ botulinum, is injected into the lower esophagus. It relaxes the muscle and prevents food from sticking.

Undesired results can occur any time you disturb tissue. The complications are rare, however. In the case of the balloon therapy, the outside chance exists of damage to the tissue of the esophagus wall. If it occurs, the patient requires corrective surgery.

Long term complement is needed regardless of which solution you choose. This is because treatments are palliative—meaning they relieve symptoms—and do not cure achalasia or stop its sequence. Symptoms can return. Your healthcare provider will want to see if your esophagus is adequately allowing food to enter your stomach and to check for gastroesophageal reflux, which would need to be treated. Your doctor will also want to observe you to be sure cancer has not developed.

Achalasia is a lifelong condition. You need to have realistic assumptions about the results of the different treatment procedures. No treatment cures achalasia. Ask your provider to discuss all the treatment choices and their success rate for controlling symptoms, the need for repeat procedures and frequency, and the hazards and advantages of each procedure.