ACHALASIA – Causes, Clinical Manifestations, Diagnostic Evaluations and Treatment
Achalasia is a rare disease of the muscle of the esophagus. Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach. This disease is also known as esophageal achalasia, Esophageal Aperistalsis, Cardiospasm and Achalasia Cardiae.
This disease refers to the inability of the Lower Esophagus Sphincter to relax and allow the food to the stomach. In many patients, the lower sphincter resting pressure is very high which an abnormal condition is. The muscles of esophagus do not contract normally due to this the saliva and food is not sent down in the stomach through esophagus. Sometimes the patients of the achalasia feel high-pressure in the lower esophagus while swallowing but these high-pressure waves are not effective in pushing the food in to the stomach
CAUSES OF ACHALASIA
There are three primary characteristics of achalasia
- Failure of the lower esophageal sphincter to relax during swallowing
- Loss of the wave-like contractions of smooth muscles (called peristalsis) that forces food through the digestive tract
- Lack of nervous stimulation to the esophagus
The main reason for achalasia is the failure of the sphincter muscle to properly relax where sphincter is a muscular ring that located at the junction of stomach and esophagus. This ring relaxes while swallowing and it allows the food and water to pass in to the stomach. It remains contracted otherwise, it prevents the digested food and stomach acids from flowing back into the esophagus.
Cancer of the esophagus or upper stomach and a parasite infection that causes chagas disease may have symptoms like those of achalasia. Different types of cancer, trauma to esophageal nerves and many other parasitic infections can cause achalasia. Sometimes achalasia is also caused due to the genetic reasons. Some genes in the human body increase the chances of this disease.
CLINICAL MANIFESTATIONS
- Vomiting
- Regurgitation
- Chest pain
- Heartburn
- Cough
- Unintentional weight loss
- Difficulty swallowing liquids and solids
- Patients may feel heavy after eating something
- The symptoms may lead to Gastro Esophageal Reflux Disease
DIAGNOSTIC EVALUATIONS
Physical examination may show signs of anemia or malnutrition. An upper GI x-ray test or barium esophagogram may show absence of peristalsis, a dilated proximal esophagus and a narrowing at the bottom of the esophagus. The diagnosis is confirmed with esophageal manometry. Endoscopy is also done to check the internal tissues of esophagus. It gives us indications about the cancerous conditions.
TREATMENT
The main aim of the achalasia treatment is to relax the esophageal sphincter muscle that makes the process of swallowing easier. The treatment of achalasia is composed of medications and as well as surgery. The surgery of achalasia may yield the Permanent cure for this disease.
1. Medications for achalasia: the medicines for achalasia include botulinum toxin and calcium channel blockers. The oral medicines that help to relax the lower esophageal sphincter include nitrates in it. These medicines are isosorbide, dinitrate and isordil.
Calcium channel blockers are the effective medication for the achalasia because it reduces the muscular contractions. The medicines for calcium channel blockers may include nifedipine, procardia and verapamil etc.
Botox injection takes 10 min and blocks the spasm of the lower esophageal sphincter. It also effective as it prevents the strong contractions of sphincter. These medications do not give the permanent relief from this disease because patients develop resistance to these drugs for few months. Botox has few side effects. The functioning of botox should be checked after every 6 months. It can also lead to scarring of muscles. It can lead to complications too.
2. Endoscopic Balloon Dilation: during balloon dilatation the surgeon places a balloon (filled with air or water) at the level of the lower esophageal sphincter. Under endoscopic vision the balloon is inflated. Thus balloon dilatation disrupts the lower esophageal sphincter and eliminates the outflow obstruction.
3. Surgery of achalasia: the achalasia surgery is also known as esophagomytomy or Heller’s Myotomy. It is considered to the permanent treatment of this disease. The purpose of this operation is to reduce the pressure in the lower sphincter muscles. A cut is made on the sphincter muscle that let it relax and makes the normal swallowing possible. The achalasia patients should be good in health because this operation puts a lot of stress on the patients so that patients have to be physically fit for the surgery