Esophageal achalasia

Overview

Achalasia is a condition that affects the movement of food and liquids from the esophagus to the stomach. The esophagus is a muscular tube responsible for transporting food from the mouth to the stomach. At the lower end of the esophagus, there is a ring of muscle known as the lower esophageal sphincter (LES), which opens and closes to allow food to enter the stomach and prevent the stomach’s contents from backing up into the esophagus.

However, in achalasia, the nerves in the esophagus become damaged, resulting in paralysis and dilation of the esophagus over time. This causes difficulty swallowing, heartburn, and chest pain.

Achalasia can lead to significant weight loss and malnutrition, and people with the condition have a slightly higher risk of developing esophageal cancer. To reduce the risk of cancer, regular screenings of the esophagus may be recommended. Unfortunately, there is currently no cure for achalasia, and once the esophagus becomes paralyzed, it cannot regain its proper function. However, the symptoms can be managed through endoscopy, minimally invasive therapy, or surgery.

Symptoms

The symptoms of achalasia typically develop gradually and become more severe over time. Common signs and symptoms are:

• Dysphagia or difficulty swallowing
• Undigested food regurgitation
• Heartburn
• Belching
• Nighttime cough
• Intermittent chest discomfort
• Weight loss or malnutrition
• Vomiting
• Hiccups, trouble belching
• Pneumonia, due to food aspiration into the lungs

Causes

The exact cause of achalasia is not well understood, but it is thought to be related to a loss of nerve cells in the esophagus. This loss of nerve cells may result in the immune system attacking the nerve cells in the muscle layers of the esophageal walls, including the lower esophageal sphincter (LES). The degeneration of nerve cells that control muscle function can lead to excessive contractions in the LES. In rare cases, achalasia may be linked to an inherited genetic disorder or infection.