Esophageal Achalasia

Esophageal Achalasia

What is achalasia? — Achalasia is a condition that affects the esophagus. The esophagus is the tube that moves food from the mouth to the stomach (figure 1). At the lower end of the esophagus, where it connects to the stomach, there is a muscle called the lower esophageal sphincter (LES). When the LES tightens, food can't move from the esophagus into the stomach. When the LES relaxes, food can move from the esophagus into the stomach.
When people have achalasia:
The lower part of the esophagus does not work normally
The LES doesn't relax, so food can't move into the stomach
What are the symptoms of achalasia? — The most common symptom of achalasia is trouble swallowing foods and drinks. Other symptoms can include:
Chest pain
Vomiting
Heartburn
Feeling like you have a lump in your throat
Losing weight without trying
Is there a test for achalasia? — Yes. If your doctor or nurse suspects that you have achalasia, he or she will do 1 or more of the following tests:
Measuring the pressure in your esophagus and LES – Your doctor will put a thin tube into your mouth or nose and down into the esophagus. The tube will measure the pressure there. This test can tell your doctor for sure if you have achalasia.
Barium swallow – Your doctor will give you a drink called "barium." Then he or she will take an X-ray as the barium moves down your esophagus (figure 2).
A procedure called an upper endoscopy – Your doctor will put a thin tube with a camera on the end into your mouth and down into your esophagus and stomach (figure 3). He or she will look at the lining of the esophagus and stomach. He or she might also take a small sample of tissue from the lining and look at the sample under a microscope.
How is achalasia treated? — Doctors can treat achalasia in different ways. Treatments cannot cure achalasia, but they can improve symptoms. The different treatments include:
Medicines – Different medicines can relax the LES. People can take these medicines before they eat.
A shot of medicine into the LES – During an upper endoscopy, a doctor can give a shot of medicine into the LES to make it relax.
Making the LES wider – During an upper endoscopy, a doctor can use a thin wire to put a special balloon through a person's mouth and down into the esophagus. The balloon is deflated until it reaches the LES. The doctor puts air into the balloon to widen the LES. Then he or she lets the air out of the balloon and removes it and the wire.
Surgery – A doctor can cut open the LES to make it wider. This can be done by making small cuts in the belly or chest, or during an upper endoscopy without cutting through the skin at all.
Which treatment is right for me? — To choose the treatment that's right for you, talk with your doctor. Ask him or her about the benefits, risks, and side effects of each treatment.
Do I need to follow up with my doctor? — Yes. You will need to follow up with your doctor on a regular basis. He or she will check that your treatment is working and that it isn't causing side effects.
Your doctor will also keep checking you for long-term problems. That's because people with achalasia have a higher than normal chance of getting cancer or other problems of the esophagus.
All topics are updated as new evidence becomes available and our peer review process is complete.
This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 16153 Version 10.0
Release: 28.2.2 - C28.105
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