Achalasia

Also Know As Cardiospasm

Achalasia

Achalasia is a rare oesophageal motility disorder, in which the muscle layer of the oesophagus loses the ability to move food downwards (aperistalsis). Further, the lower oesophageal sphincter (LOS) is unable to relax properly, preventing swallowed food from entering the stomach.

Causes

Achalasia is caused by the degeneration of neurons in the oesophagus. This phenomenon is, in itself, idiopathic, but several possible causes have been proposed, and include:

·         Infection;

·         Autoimmune disease; and

·         Genetic inheritance.

Disease pathway

The muscle of the lower oesophagus – around the nerves in particular – becomes inflamed.

The affected nerves degenerate, and eventually disappear. This damage also causes the surrounding muscle to degenerate.

As a result, the LOS loses the ability to relax, and the muscle layer cannot produce peristaltic waves.

Over time, lack of use will see the oesophagus stretch and become dilated.

Symptoms and diagnosis

The most prominent symptom of achalasia is difficulty in swallowing both solids and liquids (dysphagia), which becomes progressively worse with time. Other symptoms are also common, such as:

·         Coughing when reclined, caused by food remaining the oesophagus;

·         Chest pain due to the pressure of undigested food against the LOS;

·         Regurgitation; and

·         Weight loss and malnutrition.

A test designed specifically for achalasia is barium swallow, in which a barium sulphate solution is administered to the patient. X-ray images are taken to track the descent of the solution through the oesophagus, and information regarding the state of the system can be obtained.

Oesophageal manometry involves the insertion of a thin tube through the patient’s nose. The patient is instructed to swallow several times, and the highly-sensitive probe measures the extent of contractions in parts of the oesophagus during this process.

Treatment

Heller myotomy is a surgical procedure in which the muscles adjacent to the LOS are cut, enabling ingested foods and liquid to pass to the stomach.

Botox injections into the sphincter can also paralyse the muscles holding it shut, although this effect is only temporary. It is sometimes used to buy time while awaiting surgical treatment.

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