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Achalasia is a chronic disorder in which the esophagus can’t pass the food to the stomach efficiently. The esophagus, also called the food pipe, is the tube that connects the mouth to the stomach.
Normally, the esophageal muscles contract and push the food down towards the lower esophageal sphincter — the muscles that control the opening to the stomach. When the food reaches the lower esophageal sphincter, it relaxes and opens to let the food enter the stomach.
However, in people withachalasia, the esophageal muscles do not contract, inhibiting the flow of food towards the stomach. Also, the lower esophageal sphincter doesn’t relax upon the arrival of food, preventing food entry into the stomach.
The patient experiences difficulty swallowing and, sometimes, backflow of food towards the mouth. There is no cure for this condition but you can manage the symptoms through surgical and nonsurgical treatment options.
According toThe American Journal of Gastroenterology, around 20,000 to 40,000 people in the USA are suffering from achalasia. It mainly occurs between the age of 30 to 60 years.
The primary symptom of achalasia isdysphagia, a condition in which a person finds it hard to swallow food. Food stays in the esophagus and flows back towards the mouth. This is why achalasia is often misdiagnosed as gastroesophageal reflux disease, or GERD - a condition where food backflows from the stomach to the esophagus.
Some othersymptoms of achalasia include:
There is no clear study on what causes achalasia, but experts believe that the following factors can lead to the development of achalasia:
When food enters the esophagus, the nerve cells in the esophagus stimulate the contraction of esophageal muscles and relax the lower esophageal sphincter. These changes result in the smooth flow of food from the esophagus to the stomach.
However, when nerve cells are damaged, the contraction of esophageal muscles and relaxation of the sphincter are compromised. Thus, food can’t pass down to the stomach and starts to pile up in the esophagus, resulting in achalasia.
Studies show that herpes zoster virus, herpes simplex virus, and measles can impair the functioning of the esophagus. Anotherstudy found zoster virus DNA in the saliva of 80% of people with achalasia.
These studies indicate that viral infections can also be the cause of achalasia.
In autoimmune disorders, your body's immune system starts attacking healthy tissues.Studies show that immune cells such as eosinophils and mast cells can play a role in developing achalasia. These cells accumulate in the esophagus, triggering an autoimmune attack and damaging the esophageal tube.
Research shows that people with achalasia develop autoimmune diseases twice as much as normal people. It hints towards the association between achalasia and autoimmune disorder.
While both achalasia and dysphagia refer to difficulty swallowing, they are quite different from each other. Dysphagia is not a disease itself but a symptom of many other diseases, such as achalasia, stroke, muscular dystrophy, and Parkinson's disease.
Depending on the underlying cause, dysphagia can be mild - difficulty swallowing hard foods only. It can also be severe i.e. difficulty swallowing semi-solid foods and liquids.
In contrast, achalasia is a disease that causes dysphagia as a symptom. In achalasia, you experience dysphagia because the esophageal muscles and lower esophageal sphincter fail to work correctly.
Since the symptoms of achalasia resemble the symptoms of other digestive conditions, it is hard to diagnose it based on the symptoms. Your doctor may recommend the following tests for the correct diagnosis of achalasia:
Esophageal Manometryis thegold-standard test for diagnosing achalasia. In this test, the doctor inserts a pressure-sensitive tube from your mouth into your esophagus. The tube measures the pressure exerted on it by your esophageal muscles as you swallow.
This test tells how strongly your esophageal muscle can contract. It can also tell about the working of the lower esophageal sphincter.
Upper Endoscopyinvolves a doctor inserting a camera attached to a thin tube into your esophagus. The camera helps visualize inside the esophagus for any damage or blockage. The doctor can also perform a biopsy using an endoscope if needed. A biopsy is the process of taking a small tissue sample from inside the body for a detailed study.
The Barium Swallow Testrequires you to drink a contrast medium of barium. This contrast medium appears bright on the X-ray. As the barium flows down towards the stomach, the doctor can see its passage on real-time X-ray. It helps to detect problems with the food pipe, such as narrowing or blockages.
Achalasia is a permanent condition and there’s no complete cure for it. The treatment options available for achalasia aim to manage the symptoms and improve the condition.
Here are a few treatment options for achalasia:
Pneumatic balloon dilation is themost effective nonsurgical treatment option for achalasia. In this technique, a doctor inserts an endoscope into the esophagus, reaching the lower esophageal sphincter. A Balloon is attached to the endoscope and inflated near the esophageal sphincter. The balloon stretches the lower esophageal sphincter muscles and relaxes them for easy passage of food.
Reports show that balloon dilation treatment has a success rate of50 to 93%. One risk of balloon dilation is esophageal rupture or perforation, which occurs in1.9% of patients during the procedure.
Botulinum toxin injections, or botox, is a useful treatment option for achalasia. Botox is injected into the lower end of the esophagus. It works by inhibiting the supply of nerve impulses in the injected area, as in the lower esophageal sphincter muscles. In the absence of nerve stimulus, the lower esophageal muscles relax and open, allowing food to pass through them and enter the stomach.
Reports show that botox relieves symptoms in about78% of patients within 30 days of treatment. However, the effectiveness of botox injections reduces with time, and most patients are required to repeat the botox therapy after 12 months.
Myotomy is the most effective surgical treatment option for achalasia. In surgical myotomy, the doctor cuts the muscle fibers of the lower esophageal sphincter to release tension. The cut is made either by using an endoscope inserted through the mouth or by making a small incision in the abdominal area.
This procedure relaxes the lower sphincter muscles and allows the easy emptying of the esophagus into the stomach. Reports show that surgical myotomy has a success rate of60 to 94%.
Oral medications are convenient but theleast effective treatment option for achalasia. The two common medicines for achalasia are calcium channel blockers and nitrates. These medicines work to relax the lower esophageal sphincter muscles, allowing the food to enter the stomach.
Reports show that oral medicines have a variable success rate of0 to 87%. However, their daily dosage can result in side effects such as headache, hypotension, and pedal edema.
Unfortunately, achalasia doesn’t go away itself. Also, no treatment options can cure this condition completely. It is a chronic condition that worsens over time if left untreated.
Untreated achalasia can lead to severe esophageal dilation, nutritional deficiencies, and increased risk of esophageal cancer. Treatment options such as balloon dilation, botox injection, and surgical myotomy can help manage symptoms.
When you have achalasia, you may have a problem with swallowing certain foods only. This is because some foods can worsen the swallowing problem by causing obstruction, blockage, or irritation of the esophagus.
Here are somefoods to avoid with achalasia:
Certain foods are more likely to obstruct the esophagus than others. You may not need to avoid these foods completely, but care is needed when consuming them.
Here is a list of a few obstructive foods:
In patients with achalasia, food stays in the esophagus longer than normal. When retained in the esophagus, certain foods can solidify and convert into a hard mass that obstructs the esophagus. While solidifying foods may not block the esophagus for everyone, they are not a healthy choice overall for patients with achalasia.
Here is a list of a few solidifying foods:
Some foods, when they stay in the esophagus longer than normal, can irritate the esophageal lining. This can worsen the chest pain and discomfort in achalasia.
Here is a list of foods that can cause esophageal irritation:
Studies show that cold food and beverages worsen the symptoms of achalasia, such as dysphagia and chest pain. This is because cold temperatures increase pressure and prolong the contraction of the lower esophageal sphincter muscles.
Fiber is an extremely healthy ingredient in plant-based foods such as fruits and vegetables. Dietary fiber promotesgut health and providesother health benefits, such as improved cardiovascular health, weight management, and bowel regulation.
However, if you have achalasia, it is important to be careful about consuming fiber.Studies show that people with achalasia should limit their fiber consumption to 10 grams per day.
Insoluble fiber increases the bulk of the bolus — a mixture of food and saliva in the mouth — which can be hard to swallow with achalasia. Similarly, soluble fiber dissolves to make a gel-like substance which can be hard to pass through the compromised esophagus in achalasia.
Keep in mind that consuming fiber canreduce the frequency of heartburn, a common complaint in achalasia. To achieve the benefits of fiber while also preventing its risks in achalasia, we recommend youconsult a nutritionist. You will get expert advice on your nutritional needs depending on your condition.
Since achalasia can lead to nutritional deficiency and weight loss, it is important to choose nutrition-rich foods for your diet. However, you must ensure that the foods you eat can pass through the esophagus without causing obstruction, blockage, or irritation.
Here are someeasy-to-eat foods for achalasia:
Another way to ease Achalasia would be to choose liquid diet.Check out our juicing and smoothie meal plans here.
Achalasia is a rare swallowing disorder that disrupts the normal functioning of the esophagus. The esophageal muscles fail to contract and push the food towards the stomach. The lower esophageal sphincter also remains closed in people with achalasia, retaining food in the esophagus.
It is a chronic condition with no cure. However, nonsurgical and surgical treatment options are available that can help manage the symptoms. Along with treatment, it is essential to avoid foods that can worsen the obstruction and blockage of the esophagus.
Experts recommend soft, easy-to-eat foods to avoid problems with swallowing. You must also prefer a nutritional diet to overcome nutritional deficiency and weight loss problems with achalasia.
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