All you need to know about achalasia

Echalasia: all about achalasia

Achalasia is one of the rare digestive diseases that affect the esophagus and impede the delivery of food to the stomach, causes many symptoms, and is treated in Turkey in several ways.

overview of the esophagus

The esophagus is a muscular tube that about 25 cm long, it forms a passage for food and liquids to pass from the pharynx to the stomach.

When food is eaten the esophagus works to push the food towards the stomach through peristaltic muscle contractions aimed at moving the food and accelerating its descent into the stomach.

at the lower part of the esophagus there is a lower sphincter. The function of the lower sphincter is to prevent food from refluxing backwards into the stomach. The sphincter naturally relaxes when eating and contracts when the esophagus is empty of food or liquids.

In normal conditions, the lower esophageal sphincter maintains a specific pressure. This pressure keeps the sphincter contracted in normal conditions and prevents its relaxation and regurgitation of the components of the stomach.

A lot of digestive diseases are associated with the function of the lower esophageal sphincter gastroesophageal reflux disease One of the common diseases associated with a disorder in the work of the lower esophageal sphincter.

What is achalasia?

Achalasia or cardiospasm both refer to the same disease.

Achalasia occurs when the lower esophageal sphincter fails to relax properly while eating, preventing food from reaching the stomach.

Over time, Achalasia results in a clear expansion of the esophagus and the accumulation of food in it, which may cause the contents of the esophagus to go back towards the mouth and a feeling of bad taste.

Achalasia is often associated with many digestive symptoms that affect the patient's life. Some patients live with these symptoms and are not diagnosed with the condition until late.

At the advanced stages of the disease, paralysis of esophageal motility occurs, when this occurs, the normal function of the esophagus cannot be restored again.

The main reason behind the occurrence of achalasia is not clearly understood, but some hypotheses explain the reason for the presence of damage to the nerve plexuses responsible for esophageal motility.

This image shows a comparison between the normal state and the case of achalasia.
Achalasia

symptoms of achalasia

Some patients may not have any symptoms, but the majority of patients with achalasia complain of some symptoms, including:

  • difficulty swallowing for both solids and liquids (most common presentation)
  • Regurgitation or reflux of undigested food
  • Frequent chest pain that is exacerbated by eating
  • frequent burping
  • heartburn
  • night cough
  • Malnutrition and being underweight (due to pain that increases while eating)
  • pneumonia (caused by inhaling the contents of the digestive tract)

diagnoses of achalasia

Diagnosing this disease can be difficult because it is mixed with many other digestive diseases that cause similar symptoms.

Diagnosis of a patient with symptoms of achalasia is through several methods, including:

Barium swallow

This method is considered one of the most important methods in studying diseases of the esophagus. The patient is given a barium preparation, which is often in liquid form, and then x-rays of the esophagus are performed.

Because of achalasia, the esophagus is dilated with a narrowing at the bottom so that the esophagus takes the form of a bird's beak.

This is a radiograph of the esophagus with the radioactive barium swallowed, and we find in this image a large expansion of the esophagus with a narrowing of its lower end, which takes the form of a bird's beak, which is a distinctive appearance of the inability to relax the esophagus (Achalgia)
Picture of a barium X-rays for a patient with achalasia

upper endoscopy

The doctor inserts a flexible tube equipped with a camera through the patient’s mouth or nose to reach the esophagus, and through it he can also reach the stomach. Through endoscopy the doctor can see the esophagus and assess the occurrence of infections or cancerous growths within it. This technique helps in evaluating the complications of achalasia.

Esophageal manometry

It is considered the gold standard in diagnosing achalasia. This examination measures the time and force of esophageal contractions, in addition to measuring the pressure of the lower esophageal sphincter and determining its ability to relax properly. If the lower esophageal sphincter fails to relax after eating, this indicates acalzia.

The test is performed by inserting a flexible tube containing special sensors through the patient's nose to the stomach.

Achalasia treatment in Turkey

Several treatment options are available, all of them plan to relieve the pressure of the lower esophageal sphincter so that it can relax properly and allow food to pass into the stomach.

  Balloon dilatation

One of the easy-to-apply treatment methods that can be performed in the outpatient clinic, a balloon is inserted through the endoscope into the center of the lower esophageal sphincter, and then the balloon is inflated with air, which increases the widening of the esophageal sphincter opening and facilitates the passage of food through it.

This procedure relieves the symptoms of the disease in about 50 to 90% patients. We may need to repeat the balloon dilation procedure if the symptoms of achalasia return. According to studies, one third of patients treated with the balloon dilatation method need re-dilation every five years.

The esophageal sphincter dilatation surgery used to treat achalasia in Turkey
This image shows the dilatation of the esophageal sphincter used to treat achalasia in Turkey

Botulinum Injection (Botox)

The Botox works as a muscle relaxant that helps relax the lower esophageal sphincter, Botox is injected directly into the lower esophageal sphincter through an endoscopically guided needle.

The patient may need to re-inject Botox a large number of times (once every six months). Repeated injections of Botox make the surgical procedure difficult, so it is recommended to perform a Botox injection in patients who are not candidates for surgery or balloon dilatation.

Drug therapy

The doctor prescribes some muscle relaxants such as nitroglycerin or calcium channel blockers such as nifedipine. The effect of these drugs is weak and their side effects are numerous. Therefore, drug therapy is often the last treatment option for patients who are not candidates for other achalasia treatments.

Surgical treatment of achalasia

The surgical procedures that are performed for the management of achalasia are:

Heller process

The surgeon cut a part of the lower esophageal sphincter muscle through the endoscope, which relieves sphincter pressure and allows food to pass more easily into the stomach.

One of the complications associated with the Heller operation is the occurrence of gastroesophageal reflux disease The lower esophageal sphincter relaxes excessively, allowing food to flow backwards.

To avoid gastroesophageal reflux disease, the surgeon performs a laparoscopic fold of the stomach fundus around the lower esophageal sphincter (Nissin operation) in conjunction with the Heller operation.

Oral endoscopic myotomy

In this method, the surgeon inserts the endoscope through the mouth, and then an initial incision is made in the layers of the esophageal wall in order to reach the muscle layer.

The layers of the esophageal wall are then sutured where the incision was made.

You can us If you have a question about achalasia and how to treat it, we work at Bimaristan center To guide you to get the best medical service in Turkey.


These sources were used:

  1. Healthdirect
  2. penn medicine
  3. NHS

Common Questions

There are some foods and herbs that help relieve dysphagia, but they are not an effective way to treat the disease, but rather a way to control symptoms.

Achalasia patients are exuded by combining water with meals to facilitate its passage to the stomach. Soups, juices, and protein shakes are also useful when the patient suffers from poor appetite and severe problems with swallowing.

It is a rare disorder that affects the digestive system and causes a defect in the process of food transfer to the stomach. The pathogenic mechanism is the failure of the lower esophageal sphincter muscle to relax when eating, which prevents the passage of food into the stomach. The esophagus loses its ability to peristalsis with the passage of time and becomes paralyzed, which affects the swallowing process. The most common symptom seen in people with achalasia is dysphagia for food and drink.
  • Dysphagia of food and drink (a very common symptom in patients with achalasia)
  • Reflux or reflux of esophageal contents (undigested food)
  • smelly breath
  • Feeling of heartburn (also called heartburn)
  • Chest pain that usually increases when eating
  • Weight loss
Food ingestion disorders in people with alkalizia occur because the lower esophageal sphincter cannot relax properly. Over time, swallowing disorders may cause esophagitis and loss of the ability to peristaltic movement of the esophagus. In addition, a serious complication of acalzia is aspiration pneumonia following resorption of the contents of the digestive system. .

There are many types of treatment methods available to manage achalasia. One of the methods used to treat achalasia is balloon dilation, which is usually the first treatment option that is used when the disease is diagnosed. It is also possible that surgical intervention and an operation aimed at treating this disease and relieving its symptoms is called With Heller's procedure, Botox can also be injected down the esophagus into the loop of the lower esophageal sphincter, a type of disease management method.

The causes of achalasia are still not clearly understood, some believe that the cause is due to damage to the nerves of the esophageal plexus responsible for controlling esophageal motility, while others believe that the cause of the disorders is due to an immune factor so that special antibodies were found in the blood of some patients.

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