Achalasia

The main symptoms of achalasia are difficulty swallowing (dysphagia) both solid foods and liquids, and regurgitation of undigested food. More than 50% of eople with this condition will also have chest pain. Weight loss is rapid due to the inability to swallow. As the disease progresses, patients may experience regurgitation and aspiration of the undigested foods into the lungs that may lead to pneumonia or other lung infections. Achalasia also increases the risk of esophageal cancer.

Other symptoms include:

• the sensation of having food stuck in the chest or throat, and the need to drink liquids or eat slowly to help food pass through.
• heartburn
• coughing at night because of the difficulty swallowing

The cause is unknown. It is thought to occur from the degeneration of the nerves in the lower esophageal sphincter. The cause of this degeneration is unclear.

To diagnose achalasia, your Rockford GI doctor will inquire about your symptoms, review your medical history and perform a physical examination. They will recommend the following tests:

1. Barium Swallow: This is the best initial test to diagnose achalasia. You will be asked to swallow a liquid containing barium, a contrast material that shows up on X-rays. This allows your doctor to observe the shape and movement of your esophagus while you swallow.
2. Endoscopy: This procedure is recommended for all patients suspected to have achalasia or dysphagia to exclude precancerous and cancerous lesions of the esophagus. In this procedure, a thin, flexible tube with a camera on the end (endoscope) is passed through your mouth into your esophagus. This allows your doctor to examine the inside of your esophagus and rule out other potential causes of your symptoms.
3. Esophageal Manometry: This is the most sensitive test and is the gold standard diagnostic test. It measures the pressure and coordination of muscle contractions in your esophagus. It helps to determine if the muscles are functioning properly.
4. Esophageal pH monitoring: Prolonged pH monitoring is important to rule out GERD and determine if the treatment causes abnormal reflux.

While there is no cure for achalasia, treatment focuses on managing symptoms and improving swallowing function.

Nonsurgical options may include:

1. Drug treatments
2. Botulinum Toxin (Botox) Injection: In some cases, Botox can be injected into the LES to temporarily relax the muscle and improve swallowing. However, the effects are not long-lasting, and repeat injections may be required.
3. Balloon Dilation (Pneumatic Dilatation): This procedure involves inserting a deflated balloon into your esophagus and inflating it to stretch the tight LES, helping to improve food passage. It is a non-surgical option and may need to be repeated periodically.

Surgical options that may be considered include:

1. Surgical Myotomy: This surgical procedure involves cutting the muscles of the LES to allow easier passage of food and liquids into the stomach. It can be done using minimally invasive techniques (POEM) or open surgery.
2. Peroral endoscopic myotomy (POEM): POEM is a minimally invasive intervention and an alternative to traditional surgery designed to improve esophageal function and eliminate swallowing difficulties by releasing the sphincter muscles.

Your Rockford Gastroenterology Associates doctor will recommend the most suitable treatment approach based on the severity of your symptoms and your overall health.

Long-term Outlook: With appropriate treatment, most individuals with achalasia experience significant improvement in their ability to swallow. However, it’s important to note that achalasia is a chronic condition that requires ongoing management. Regular follow-up with your Rockford GI doctor is essential to monitor your progress, make any necessary adjustments to your treatment plan, and address any concerns you may have.