What is Achalasia?
Achalasia is a rare condition where the muscles in the esophagus (the tube that carries food from the mouth to the stomach) have trouble moving food down because the lower esophageal sphincter (a valve at the bottom of the esophagus) doesn’t relax properly.
What Are The Causes Of Achalasia?
1. Nerve Damage (Primary Cause)
- Degeneration of Nerve Cells: Achalasia is often linked to the loss of nerve cells in the esophageal wall (specifically the myenteric plexus) which controls muscle contractions.
- This degeneration disrupts the normal coordination of esophageal muscles and cause to difficulty swallowing and the inability of the LES to relax.
2. Autoimmune Factors
- Achalasia may result from the immune system mistakenly attacking the esophageal nerves in some cases.
- This autoimmune response could be triggered by a viral infection or other environmental factors.
3. Infections
- Some infections can contribute to the development of achalasia.
- Chagas Disease: Caused by the parasite Trypanosoma cruzi. This condition can damage nerves in the digestive system and mimic achalasia.
- Viral infections (like as herpes simplex or varicella-zoster virus) have also been suggested as potential contributors.
4. Genetic and Familial Factors
- Achalasia is rarely inherited but familial cases have been reported.
- It may be associated with certain genetic syndromes like down syndrome or allgrove syndrome (also known as triple A syndrome).
5. Secondary Causes (Pseudachalasia)
- Achalasia-like symptoms are caused by other conditions in some cases.
- Esophageal Cancer: Tumors near the gastroesophageal junction may block the esophagus.
- Paraneoplastic Syndromes: Some cancers types can lead to immune responses that mimic achalasia.
Statistics About Achalasia
Prevalence of Achalasia
- Worldwide: Achalasia effects about 1 in 100,000 people annually.
- Overall Prevalence: Estimated at 10 to 15 cases per 100,000 people in the general population.
- It is considered equally distributed across most geographic regions.
Demographics
- Age:
- Achalasia could be seen at any age but it is most commonly diagnosed between ages 25 and 60.
- Smaller peak occurs in children and teenagers however pediatric cases are rare.
- Gender:
- It appears to effect men and women equally but some studies suggest a slight female predominance.
Risk Factors and Associations
- Genetic Factors: Rare familial cases account for less than 2% of all achalasia diagnoses.
- Chagas Disease:
- A major cause of achalasia-like symptoms in Latin America.
- In regions where Trypanosoma cruzi is endemic and Chagas disease significantly increases the incidence of achalasia-like esophageal dysfunction.
- Idiopathic Cases:
- Majority of achalasia cases are idiopathic. İt is meaning the exact cause is unknown.
Treatment Outcomes of Achalasia
- Success Rates:
- Pneumatic Dilation: Achieves significant symptom relief in about 60-90% of patients but may require repeated procedures.
- Heller Myotomy: Considered highly effective with success rates over 90% especially when combined with fundoplication to reduce reflux.
- Peroral Endoscopic Myotomy (POEM): Newer technique with comparable success rates to Heller myotomy.
- Relapse:
- About 10-20% of patients may experience symptom recurrence after initial treatment and so requiring further intervention.
Prognosis of Achalasia
- Life Expectancy of Achalasia;
- Achalasia itself doesn’t typically reduce life expectancy if properly treated.
- Untreated cases can cause to severe complications such as malnutrition, aspiration pneumonia and esophageal cancer.
- Cancer Risk of Achalasia;
- Patients with achalasia have a slightly increased risk of developing esophageal squamous cell carcinoma with lifetime risk estimated at 1-5%.
What Are The Symptoms Of Achalasia?
1. Difficulty Swallowing (Dysphagia)
- What Happens?
- Both solids and liquids become increasingly hard to swallow. Unlike other conditions where only solids are initially affected.
- Patients can describe it as feeling like food gets “stuck” in the chest or throat.
- Progression
- Dysphagia could occur only occasionally but becomes persistent over time.
- Advanced cases may cause to avoidance of eating in social situations.
2. Regurgitation of Undigested Food
- What Happens?
- Food and saliva that can’t pass through the esophagus into the stomach and may flow backward into the throat or mouth.
- Different from vomiting; regurgitated material is undigested and there is no nausea.
- When It Occurs?
- Often happens when lying down, bending over or at night and lead to discomfort or choking.
- Risks:
- Chronic regurgitation can cause to aspiration pneumonia (food or liquids enter the lungs and cause infection).
3. Chest Pain
- What Happens?
- Pain or tightness in the chest which can last for minutes to hours.
- Often described as a squeezing or burning sensation and sometimes mistaken for heart-related pain.
- When It Occurs?
- Could be triggered by eating or happen spontaneously.
- Why It Happens?
- Caused by uncoordinated esophageal muscle contractions or prolonged food retention.
4. Heartburn or Acid Reflux Sensations
- What Happens?
- A burning feeling in the chest is common but unlike GERD, it’s not beacuse of stomach acid.
- Retained food in the esophagus can ferment and cause to similar discomfort.
5. Weight Loss
- Why It Happens?
- Difficulty swallowing and vomiting reduce the amount of food intake.
- Anxiety about eating may contribute to reduced appetite.
- Severity:
- Weight loss can become significant in advanced cases and requiring medical intervention.
6. Coughing and Nighttime Symptoms
- What Happens?
- Coughing (especially at night) occurs when regurgitated material enters the throat or airway.
- Patients may wake up choking or coughing.
- Complications:
- Nighttime symptoms could disrupt sleep and cause to aspiration pneumonia or chronic respiratory issues.
7. Hiccups or Difficulty Burping
- Why It Happens?
- Irritation or pressure in the diaphragm from food retention can lead to persistent hiccups.
- Some patients report difficulty burping because the esophagus fails to expel trapped air effectively.
Other Possible Symptoms:
- Bad Breath (Halitosis): Caused by the fermentation of undigested food in the esophagus.
- Fatigue or Weakness: Resulting from malnutrition or poor food intake over time.
Symptom Impact and Severity:
The severity of symptoms could be change according to;
- In early stages, symptoms might be mild or mistaken for other conditions like GERD or anxiety.
- In advanced stages, symptoms can lead to malnutrition, dehydration and serious respiratory complications.
5 Advice For Living With Achalasia
1. Work Closely with Your Doctor
- Follow-up Appointments: Regular check-ups ensure your treatment is effective and screen for complications.
- Treatment Adherence: Stick to prescribed treatments such as medications, dilation or surgery recommendations.
2. Modify Your Diet
- Choose Softer Foods: Eat soft, moist foods that are easier to swallow like soups, yogurt or mashed vegetables.
- Chew Thoroughly: Take small bites and chew food completely before swallowing.
- Stay Hydrated: Drink plenty of water during meals to help wash food down.
- Avoid Trigger Foods: Limit foods that are difficult to swallow or increase reflux such as dry, sticky or spicy items.
- Meal Timing:
- Eat smaller and more frequent meals.
- Avoid eating close to bedtime to reduce regurgitation risk.
3. Adjust Your Eating Position
- Sit Upright While Eating: Helps gravity assist in moving food through the esophagus.
- Avoid Lying Down After Meals: Wait at least 2–3 hours before lying down.
- Elevate Your Head While Sleeping: Use extra pillows or a wedge to reduce regurgitation and nighttime aspiration.
4. Practice Symptom Management
- Monitor Symptoms: Keep track of changes in swallowing, regurgitation or chest pain to inform your doctor.
- Prevent Aspiration: Be cautious about regurgitation at night to avoid choking or food entering your lungs.
5. Stay Physically Active
- Regular light exercise can improve digestion and overall well-being.
- Avoid heavy physical activity immediately after meals.
We wish healthy and happy life to you. Also you can find most effective Achalasia treatmet option Heller Myotomy surgery in below link:
Please follow and like us:
