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Achalasia (Difficulty Swallowing)

What is achalasia?
What are the signs of achalasia?
What causes achalasia?
How does my doctor tell if I have achalasia?
How is achalasia treated?

What is achalasia?

Achalasia is a condition when the muscles of the esophagus - the tube that carries food from the mouth to the stomach - do not work correctly. Because the esophagus is slow to move food toward the stomach, and the valve at the bottom of this feeding tube does not open as it should, food becomes trapped in the esophagus. This is a rare condition that is most common in middle-aged or older adults.

What are the signs of achalasia?

The most obvious and frequent symptom of achalasia is trouble swallowing. Other symptoms may include:

  • Vomiting, or regurgitating food immediately after a meal
  • Unintentional weight loss
  • Heartburn
  • Chest pain that may be worse after eating
  • Feeling full after eating a small amount of food
  • Taking a long time to eat a meal
  • Coughing, which may be caused by food entering the windpipe and lungs

What causes achalasia?

At the bottom of your esophagus is a band of muscles that opens and shuts when you swallow. This allows food into the stomach, and then keeps the stomach's contents from rising into the esophagus during digestion. In achalasia, this muscle, or sphincter, clamps shut and does not open the right way when you swallow. In addition, the muscles in the esophagus no longer move food toward the stomach in a normal, wave-like fashion.

Doctors are unclear about the underlying cause of achalasia. It may be caused by damage to the nerves in the esophagus, possibly triggered by a viral infection.

How does my doctor tell if I have achalasia?

If your doctor believes you may have achalasia, he or she may recommend any of these tests:

  • In an upper gastrointestinal endoscopy, the doctor uses an endoscope - a tiny video camera mounted on a thin, flexible tube with a light at the end - to look inside your esophagus and stomach. The doctor inserts the endoscope through your mouth. You will be given medication to make you relaxed and drowsy during the procedure, which only takes 15-20 minutes.
  • An upper gastrointestinal X-ray (upper GI series) shows the condition of your esophagus and stomach. Before the test, you will drink a chalky material that helps the esophagus and stomach show up on the X-ray.
  • An esophageal manometry motility study tests the muscles of the esophagus as well as the band of muscles at its bottom . The doctor inserts a thin, flexible tube that has pressure sensors on its sides into one nostril of your nose, and eases it down into your esophagus. You will be asked to swallow several times while the doctor takes readings of the muscle contractions. The test takes 20 to 30 minutes.

How is achalasia treated?

Non-surgical

  • Botulinum Toxin - also known as Botox - paralyzes muscles and prevents spasms. By injecting Botox into the band of muscles at the bottom of the esophagus, a doctor can temporarily relax those muscles, and allow you to swallow. The doctor will use an endoscope - a thin, flexible tube with a light and a tiny video camera at its tip - to inject the Botox. The treatment can last for several months.
  • A doctor can open, or dilate, the band of muscles at the bottom of the esophagus by passing a small balloon down the esophagus and into the band of muscles. The doctor then inflates the balloon, which stretches and weakens the muscles. This treatment can last far longer than a Botox injection, but may cause the patient some pain. In rare cases, it can harm the esophagus.

Surgical

  • In a myotomy, a surgeon permanently weakens the band of muscles at the bottom of the esophagus by cutting them. A new laparoscopic procedure uses images from a tiny video camera to help the surgeon cut the muscles. Only small incisions are needed in this kind of surgery. A patient can leave the hospital after a few days, and can return to work within two weeks.
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