Achalasia is of a Greek derivation and means lack of relaxation. It is caused due to damage to the nerve plexus of the esophagus. This results to impaired esophageal contractions along its length and to inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach.
- Dysphagia: it is the most common of the symptoms. The patient has difficulty in swallowing both liquids and solids.
- Chest pain : mimicking angina of the myocardial infarction
- Regurgitation of food: this results to halitosis
- Coughing and choking: episodes of asphyxiation, particularly at night when the patient is sleeping and due to regurgitation, food can enter the throat causing aspiration pneumonia.
- The patient presents with weight loss, Esophagitis (inflammation of the esophagus), esophageal ulcers which can lead to esophageal cancer.
- Video-Esophagram in which video X-rays of the esophagus are taken after barium is swallowed. ( the video-esophagram shows that the esophagus is dilated (enlarged or widened), with a characteristic tapered narrowing of the lower end, sometimes likened to a “bird’s beak.” )
- Manometry a thin tube is inserted through the nose down the back of the throat . This tube can detect and record the pressures along the esophageal tube.
- Endoscopy it may be helpful in the diagnosis but its main role is to exclude other diseases such as esophageal cancer.
- Oral medication they help the lower esophageal sphincter to relax relieving the symptoms.
- Dilation: a special balloon placed across the lower sphincter causes partial rupture of the muscle fibers of the esophagus.
- Surgery (esophagomyotomy) the lower esophageal sphincter muscle is cut partially and the operation is combined with an acid reflux procedure(fundoplication), so that gastric fluids not to regurgitate to the esophagus). The operation can be done laparoscopically.It is the most effective method for the treatment of achalasia with excellent results.