Achalasia – Symptoms, Diagnosis, Causes and Treatment

What is Achalasia?

Achalasia definition: It is a rare disorder where the muscles of the oesophagus (the tube that carries food from the throat to the stomach) lose their ability to push food down. The lower oesophagal sphincter (LES), a valve that allows food to enter the stomach, fails to relax properly, causing food and liquids to be trapped in the oesophagus.

Symptoms of Achalasia

The symptoms of achalasia often develop gradually and may worsen over time. Some of the key symptoms include:

• Difficulty swallowing (dysphagia).
• Regurgitation of undigested food.
• Chest pain, particularly after eating.
• Weight loss without trying.
• Heartburn-like sensation.
• Coughing, especially when lying down.
• The feeling of food being stuck in the throat.
• Inability to burp.

Recognising these symptoms early is critical, as they can often be mistaken for more common conditions like GERD (Gastroesophageal Reflux Disease).

Causes of Achalasia

The causes of achalasia are not entirely clear, but a combination of genetic, autoimmune, and environmental factors seem to play a role. Potential causes include:

• Genetic predisposition: Some cases may be linked to family history.
• Autoimmune response: The body’s immune system mistakenly attacks healthy nerve cells in the oesophagus, leading to loss of function.
• Viral infections: Some researchers suggest that viral infections may trigger an autoimmune reaction, contributing to the development of achalasia.
• Chagas disease: This parasitic infection, common in parts of Latin America, has been linked to achalasia.

Understanding the Achalasia causes is key to determining the most suitable treatment approach.

How is Achalasia Diagnosed?

Accurate and timely achalasia diagnosis is crucial for managing the condition effectively. Diagnostic methods often involve:

• Barium Swallow X-ray: Patients are asked to swallow a barium solution that shows up on X-rays, highlighting any narrowing or blockage in the oesophagus.
• Endoscopy: A small camera is inserted into the oesophagus to examine any abnormalities. This test also helps to rule out conditions like oesophagal cancer.
• Esophageal Manometry: This test measures the rhythmic muscle contractions in the oesophagus when swallowing and the function of the LES. It is often considered the most reliable method for diagnosing achalasia disease.

Treatment Options for Achalasia

While there is no cure for achalasia, several achalasia treatment options can help manage symptoms and improve quality of life:

• Medications: Nitrates and calcium channel blockers can help relax the LES, allowing food to pass through more easily. However, these are usually short-term solutions.
• Botox Injections: Botox can temporarily relax the LES, offering relief for several months. This is particularly useful for patients who are not candidates for surgery.
• Pneumatic Dilation: A balloon is inserted into the oesophagus and inflated to stretch the LES. While effective, this treatment may need to be repeated.

Surgical Procedures for Achalasia

For severe cases, surgery may be the most effective achalasia treatment. Common surgical options include:

• Heller Myotomy: This involves cutting the muscle fibres of the LES to reduce pressure and allow food to pass more easily.
• Peroral Endoscopic Myotomy (POEM): A less invasive endoscopic surgery where the oesophagus lining is cut to create a tunnel, enabling smoother food passage.
• Esophagectomy: In rare cases where other treatments fail, removing part or all of the oesophagus may be necessary.

Diet Recommendations for Achalasia Patients

Following a specialised diet can help manage symptoms. Some dietary tips include:

• Eating smaller, frequent meals.
• Chewing food thoroughly and eating slowly.
• Avoiding foods that are difficult to swallow, like dry or sticky foods.
• Drinking plenty of water during meals.
• Avoiding meals before bedtime.
• Elevating the head while sleeping to prevent regurgitation.

Foods to avoid include acidic foods like citrus fruits, spicy dishes, caffeine, and alcohol, as these can exacerbate symptoms.

Complications of Achalasia

If left untreated, achalasia can lead to severe complications:

• Megaesophagus: A massively dilated esophagus.
• Esophagitis: Inflammation caused by retained food and liquids.
• Esophageal Perforation: A tear in the oesophagus, leading to life-threatening infections.
• Aspiration Pneumonia: Inhalation of food particles into the lungs can cause serious respiratory issues.
• Increased Cancer Risk: Long-standing achalasia slightly increases the risk of developing oesophagal cancer.

Prognosis for Achalasia

Early diagnosis and appropriate treatment can significantly improve outcomes. However, most patients will need lifelong management to control symptoms. Some may require multiple treatments, and lifestyle adjustments are often necessary.

Preventative Measures for Achalasia

Since the exact causes of achalasia remain unknown, specific prevention strategies are limited. However, early detection and prompt treatment can minimize complications. Maintaining a healthy lifestyle and seeking regular medical checkups can aid in managing the disease effectively.

Conclusion

Achalasia may be a rare disorder, but its impact can be life-altering. By understanding the symptoms of achalasia, available achalasia treatment options, and the importance of early achalasia diagnosis, patients can significantly improve their quality of life. Additionally, having a comprehensive Online Health Insurance plan from Bajaj Allianz General Insurance Company can offer the financial support needed to manage such chronic conditions effectively. Regular checkups, timely treatment, and lifestyle modifications remain key to living well with achalasia.

FAQs

1. How can I find a specialist for achalasia treatment?

You can start by consulting a gastroenterologist who specialises in oesophagal disorders. Bajaj Allianz’s Online Health Insurance offers a wide network of specialists and hospitals for managing conditions like achalasia.

2. How does achalasia impact mental health, and what support resources are available?

Chronic conditions like achalasia can lead to anxiety and depression. Support groups, therapy, and counselling services can be beneficial in managing mental health alongside physical symptoms.

3. Are there any alternative therapies for treating achalasia?

While there’s limited scientific backing, some patients explore acupuncture and herbal remedies as complementary therapies. Always consult your doctor before trying alternative treatments.

4. What is the difference between achalasia and GERD (Gastroesophageal Reflux Disease)?

While both conditions affect the oesophagus, achalasia involves difficulty in swallowing due to a non-relaxing LES, while GERD is characterised by acid reflux caused by a weak or malfunctioning LES.

5. What medications are commonly prescribed for achalasia?

Commonly prescribed medications include calcium channel blockers, nitrates, and in some cases, sildenafil, which help relax the LES.

6. How does achalasia affect daily life and activities?

Activities like eating can be difficult, requiring smaller meals, thorough chewing, and sometimes avoiding social gatherings involving food.

7. How can I manage achalasia symptoms at home?

Home management includes dietary adjustments, sleeping in an elevated position, and taking prescribed medications regularly.

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