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  Information on  Achalasia

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What is Achalasia syndrome

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INTRODUCTION Achalasia is a rare swallowing disorder that affects only 1 in every 100,000 people. Patients typically first note increasing difficulty swallowing. Most people are diagnosed between the ages of 25 and 60 years. It is usually a chronic condition that worsens over time and does not resolve.

Several different treatments are available. Each treatment has advantages and disadvantages. It is important to discuss the various treatment options with your doctor before making a decision.

CAUSE The specific cause of achalasia is unknown. However, patients with achalasia have two problems in the esophagus (the tube which carries food from the mouth to the stomach).

  • The first is that the lower two-thirds of the esophagus does not propel food toward the stomach properly.

Damage to the LES and esophagus causes large volumes of food and saliva to accumulate in the esophagus. Patients can initially compensate for this but eventually the barrier progresses to the point where food and saliva cannot reliably enter the stomach, and, as a result, build up in the esophagus.

SYMPTOMS The symptoms have a slow onset and progress gradually; many people delay seeking medical attention until symptoms are advanced. The major symptom is difficulty swallowing (liquids or solids). Other symptoms include chest pain, regurgitation of swallowed food and liquid, heartburn, difficulty burping, a sensation of fullness or a lump in the throat, hiccups, and weight loss.

DIAGNOSIS Achalasia is usually suspected based upon the presence of the symptoms described above,

Chest x-rays A simple chest x-ray may reveal distortion of the esophagus and absence of air in the stomach, two abnormalities that suggest achalasia.

Barium swallow test The barium swallow test is the primary screening test for achalasia. The test involves swallowing a chalky-tasting, thick mixture of barium while x-rays are taken. The barium shows the outline of the esophagus and LES .

 

After the barium swallow, patients should drink extra fluid. Stools may be light in color for a few days after testing as a result of the barium.

Manometry Manometry refers to the measurement of pressure within the esophagus and the LES. Pressures are measured by advancing a thin tube through the mouth or nose into the esophagus. The test is done after patients have had nothing to eat or drink for eight hours, while patients are awake. Patients will be asked to swallow while the tube is in place.

Manometry is always used to confirm achalasia. The test typically reveals three abnormalities in people with achalasia: high pressure in the LES at rest, failure of the LES to relax after swallowing, and an absence of useful (peristaltic) contractions in the lower esophagus. The last two features are the most important and are required to make the diagnosis.

Endoscopy Endoscopy allows for direct visualization of the inside of the esophagus, LES, and stomach using a thin, lighted, flexible tube. Endoscopy is done while a patient is sedated. This test is usually recommended for people with suspected achalasia and is especially useful for detecting other conditions that mimic achalasia.

In people with achalasia, endoscopy often reveals distortion of the esophagus and the presence of residual food;  Having a biopsy while sedated is not painful and is very safe.

TREATMENT Several options are available for the treatment of achalasia. Unfortunately, none can halt or reverse the underlying problem. However, all of the treatments are effective for improving symptoms.

Two of these treatments (drug therapy and botulinum toxin injection) work by reducing the LES pressure while two other treatments (balloon dilatation and surgery (myotomy)) work by mechanically weakening the muscle fibers of the LES.

Drug therapy Two classes of drugs, nitrates and calcium channel blockers have muscle-relaxing effects. These drugs can relax the LES and decrease symptoms in people with achalasia. They are usually taken by placing a pill under the tongue 10 to 30 minutes before meals.

Balloon dilatation (pneumatic dilatation) Balloon dilatation mechanically stretches the contracted LES. This procedure is effective for relieving symptoms of achalasia in two-thirds of patients, although chest pain persists in some people. Up to half of patients may require more than one treatment for adequate relief. Patients receive general anesthesia and are generally able to go home at the end of the day.

  Procedure People undergoing balloon dilatation are typically placed on a liquid diet 12 hours to two days in advance