Achalasia

Overview

Achalasia is a disorder making it difficult for food and drink to pass into the stomach (dysphagia) and causing the backflow of undigested food into the throat. The cause of primary achalasia is unknown. Owing to damage to the nerves in the oesophagus, the ring of muscle at the lower end of the oesophagus fails to open properly to let food into the stomach.

Symptoms

• Difficulty and unpleasant feeling when swallowing (dysphagia)
• Urge to drink lots of water to wash the food down
• Bringing back up undigested, non-acidic food (regurgitation)
• Bad breath
• Seldom, cramping pain in the chest, behind the sternum
  • Often initially misdiagnosed as coronary heart disease
• Weight loss (because of impaired food intake)

Complications

• Inhalation of regurgitated food (aspiration), risk of aspiration pneumonia
• Progressive weight loss
• Oesophageal mucosa can become inflamed (oesophagitis)
  • Higher risk of oesophageal cancer

Causes and treatment

Causes

Primary achalasia

• Most common form
• Degeneration (wear and tear) of the nerve cells in the oesophagus and subsequent impairment of the swallowing process (causes are unknown)
• The ring of muscle at the lower end of the oesophagus (lower oesophageal sphincter) fails to open up during swallowing

Secondary achalasia

• Pre-existing processes or disorders (e.g. oesophageal cancer or stomach cancer)
• Narrowing and compressing of oesophagus

Further treatment by your doctor / in hospital

Possible tests

• Endoscopy of gullet (oesophagoscopy)
  • Incl. removal of a tissue sample (to exclude oesophageal cancer)
• Measurement of oesophageal pressure (manometry)
• X-ray: barium swallow test (to show the swallowing process)

Possible therapies

• Medication (nifedipine)
  • To relax the muscles in the lower oesophagus
  • Disappointing long-term results
• Pneumatic balloon dilation
  • Preferred method
  • Stretching of oesophageal sphincter with a balloon catheter
  • Long-term success rate of 60% for permanent symptom relief
• Injection of botulin toxin (Botox) into the oesophageal sphincter
  • Muscle is partially paralysed; improved passage of food into stomach
  • Second-best method
• Surgical treatment
  • Laparoscopy (keyhole surgery)
  • Success rate is 90%
  • Preferred method for younger patients

What can I do myself?

• Generally, a doctor must be consulted (see below)
• Several small meals rather than a few big meals
• Wash food down with water (reduces the irritation of the oesophageal mucosa)
• Elevate the upper body
• Devote time to sport and hobbies

When to see a doctor?

• Chest pressure or pain behind the sternum
• Regular regurgitation of food
• Problems with the swallowing process
• Frequent choking, chronic coughing, shortness of breath
• Involuntary weight loss
• Night sweats and fever

Further information

Achalasie Selbsthilfe e.V. (D) (German Achalasia Self-Help Support): Recommended measures

Synonyms

achalasia, swallowing disorder, dysphagia