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Achalasia

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Updated August 07, 2011

Alternative names

Esophageal achalasia

What is Achalasia?

Achalasia is a disorder of the esophagus that affects the esophagus' ability to move food toward the stomach. Also, the valve from the esophagus to the stomach (lower esophageal sphincter or LES) does not relax enough during swallowing to allow food to enter the stomach.

Characteristics of Achalasia

There are three primary characteristics of achalasia:
  • Failure of the LES 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.


Causes of Achalasia

  • Damage to the nerves to the esophagus
  • Parasitic infection
  • Cancers
  • Hereditary factors.

Risk factors for achalasia

Achalasia is a rare disorder, may occur at any age, but is most common in middle-aged or older adults.

Symptoms of Achalasia

  • Difficulty swallowing liquids and solids
  • Regurgitation of food
  • Chest pain which may increase after eating or may radiate to the back, neck, and arms
  • Unexplained weight loss
  • Heartburn
  • Cough

Diagnostic Tests for Achalasia

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. Physical examination may show signs of anemia.

Treatment of Achalasia

  • The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter with special instruments.

  • Therapy usually involves dilation of the lower sphincter or injection with botulinum toxin to paralyze it and prevent spasms. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter.

  • Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.

Prognosis for Achalasia Patients

Surgical outcomes are good -- dilation alone often results in only temporary improvement in symptoms.

Complications of Achalasia

  • Tearing (perforation) of the esophagus
  • Regurgitation of acid or food from the stomach into the esophagus (reflux)
  • Aspiration of food contents into the lung that can cause pneumonia

Prevention of Achalasia

Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.

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