Achalasia: Symptoms, Causes, Treatment

What are the symptoms of achalasia?

Achalasia is a rare disorder of the esophagus that makes it difficult for food and liquid to pass into your stomach. The primary symptoms of achalasia include:

1. Difficulty swallowing (dysphagia): This is the most common symptom. Initially, you might have trouble swallowing foods or liquids, especially solid foods, but as the condition worsens, you may find it difficult to swallow even liquids.
2. Regurgitation of food: Food can come back up into your throat without warning, sometimes causing choking.
3. Chest pain or discomfort: You might experience pain or discomfort in your chest, often behind your breastbone, that can be severe and may feel like heartburn.
4. Weight loss: Difficulty swallowing can lead to unintentional weight loss due to inadequate food intake.
5. Heartburn: Some people with achalasia experience heartburn or a sensation of acid reflux due to the backup of food and acid in the esophagus.
6. Coughing or aspiration: If food or liquid enters your airway, it can lead to coughing, aspiration pneumonia, or recurrent lung infections.

These symptoms can vary in severity and may worsen over time if left untreated. If you’re experiencing any of these symptoms, it’s important to see a healthcare provider for an accurate diagnosis and appropriate treatment.

What are the causes of achalasia?

The exact cause of achalasia is unknown, but it is believed to be due to damage to the nerves of the esophagus. The esophagus is the muscular tube that connects the throat to the stomach. In achalasia, the muscles of the lower esophageal sphincter (LES) fail to relax properly, making it difficult for food and liquid to pass into the stomach.

Several theories exist regarding the causes of this nerve damage, including:

1. Autoimmune reaction: Some researchers believe that achalasia may be an autoimmune disorder, where the body’s immune system mistakenly attacks the nerves in the esophagus.
2. Genetics: There may be a genetic predisposition to achalasia, as it sometimes runs in families.
3. Viral infection: Some viral infections, such as herpes or the human papillomavirus (HPV), have been suggested as potential triggers for achalasia, but more research is needed to establish a clear link.
4. Abnormalities in nerve cells: Changes in the nerve cells of the esophagus, known as ganglion cells, may play a role in the development of achalasia.
5. Degeneration of the nerves: The nerves that control the muscles of the esophagus may degenerate over time, leading to achalasia.

It’s important to note that while these theories suggest possible causes, the exact cause of achalasia is still not fully understood. More research is needed to determine the underlying mechanisms of this condition.

What is the treatment for achalasia?

Treatment for achalasia aims to relieve symptoms by helping the lower esophageal sphincter (LES) to relax and allow food and liquids to pass into the stomach more easily. The following are common treatment options:

1. Medications: Medications can help relax the LES and make swallowing easier. These may include nitrates, calcium channel blockers, or botulinum toxin (Botox) injections into the LES.
2. Dilation: This procedure involves stretching the LES using a balloon or a dilating device during an endoscopy. Dilation helps widen the opening of the LES and improve swallowing.
3. Surgery: If medications and dilation are not effective, surgery may be recommended. The most common surgery for achalasia is called a Heller myotomy, which involves cutting the muscles at the LES to help it relax.
4. Peroral endoscopic myotomy (POEM): This is a minimally invasive procedure where a scope is passed through the mouth into the esophagus to perform a myotomy, similar to the surgical approach, but without external incisions.
5. Laparoscopic surgery: In some cases, laparoscopic surgery may be performed to access the LES and perform a myotomy.
6. Botox injections: Botulinum toxin (Botox) injections can be used to temporarily relax the LES, but the effects typically last only a few months and the procedure may need to be repeated.
7. Nutritional support: In severe cases where swallowing is severely impaired, nutritional support such as a feeding tube or a liquid diet may be necessary.

The choice of treatment depends on the severity of symptoms, the overall health of the patient, and the preferences of the healthcare team and the patient. It’s important to discuss the risks and benefits of each treatment option with a healthcare provider to determine the most appropriate approach for managing achalasia.

What is a good diet for somebody with achalasia?

Achalasia can make swallowing difficult, so it’s important to choose foods that are easier to swallow and digest. Here are some dietary tips for someone with achalasia:

1. Soft foods: Choose soft, moist foods that are easier to swallow, such as yogurt, pudding, mashed potatoes, smoothies, and soup.
2. Small, frequent meals: Eating smaller meals more frequently can help prevent the feeling of fullness and make swallowing easier.
3. Well-cooked vegetables: Cook vegetables until they are soft and easy to chew, or puree them into soups or smoothies.
4. Moist foods: Foods with higher moisture content, such as sauces, gravies, and broths, can be easier to swallow.
5. Avoid tough or dry foods: Avoid foods that are hard to chew or swallow, such as tough meats, dry bread, and raw vegetables.
6. Cut food into small pieces: Cutting food into smaller pieces can make it easier to swallow.
7. Avoid carbonated drinks: Carbonated drinks can cause gas and bloating, which can worsen symptoms of achalasia.
8. Stay upright after eating: Avoid lying down immediately after eating, as this can increase the risk of food regurgitation.
9. Stay hydrated: Drink plenty of water throughout the day to help prevent dehydration and keep the esophagus moist.
10. Avoid alcohol and caffeine: These can relax the lower esophageal sphincter and worsen symptoms.

It’s important to listen to your body and eat slowly, taking small bites and chewing thoroughly. If you have achalasia, you may need to work with a dietitian to develop a meal plan that meets your nutritional needs while minimizing discomfort.