Esophageal achalasia (muscle dysfunction)

Abdomen | Gastroenterology | Esophageal achalasia (muscle dysfunction) (Disease)


Description

Esophageal achalasia is a rare disease of the muscle of the esophagus. The esophagus is the tube that connects the mouth to the stomach. Achalasia occurs when the lower esophageal sphincter fails to relax and let food pass into the stomach. The cause of the disorder is unknown, and is more common in older patients.

The main symptoms of achalasia are dysphagia (difficulty in swallowing), regurgitation of undigested food, chest pain behind the sternum, and weight loss. Dysphagia tends to become progressively worse over time and to involve both fluids and solids. Some people may also experience coughing when lying in a horizontal position. The chest pain experienced, also known as cardio spasm and non-cardiac chest pain can often be mistaken for a heart attack. It can be extremely painful in some sufferers. Food and liquid, including saliva, are retained in the esophagus and may be inhaled into the lungs (aspiration).

Causes and Risk factors

The cause of achalasia is unknown. Theories on causation invoke infection, heredity or an abnormality of the immune system that causes the body itself to damage the esophagus (autoimmune disease).

In achalasia there is an inability of the lower sphincter to relax and open to let food pass into the stomach. In at least half of the patients, the lower sphincter resting pressure (the pressure in the lower sphincter when the patient is not swallowing) also is abnormally high. In addition to the abnormalities of the lower sphincter, the muscle of the lower half to two-thirds of the body of the esophagus does not contract normally, that is, peristaltic waves do not occur, and, therefore, food and saliva are not propelled down the esophagus and into the stomach.

Diagnosis and Treatment

Treatments for achalasia include oral medications, stretching of the lower esophageal sphincter (dilation), surgery to cut the sphincter (esophagomyotomy), and the injection of botulinum toxin (Botox) into the sphincter. All four treatments reduce the pressure within the lower esophageal sphincter to allow easier passage of food from the esophagus into the stomach. ...