Achalasia

Achalasia is a condition in which the lower esophageal sphincter (LES), which is present at the start of the stomach, fails to open during swallowing of food. This defect in the LES leads to food regurgitation and is accounted to LES nerve damage. The oesophagus is a tube which connects the throat and pharynx with the stomach. This oesophageal tube is located between the windpipe and trachea and is approximately 25 cms long. In a normal oesophagus, the muscles contract upon swallowing of food and pushes the food into the stomach. This mechanical digestion of food is possible only because of the aid of the oesopheageal tube. The glands present, on the muscular walls of the oesophagus, secrete mucus which allows easy passage to the swallowed food. In esophageal achalasia, the oesophagus loses its contractility and the muscles of the oesophagus become spastic due to some autoimmune disease or immunity-supressing viral infections. The inability of the oesophageal muscle to let the food pass through is known as aperistalsis in which the oesophageal muscles do not contract. It is suggested that 3000 people per year are diagnosed with Achalasia in the United States. Achalasia might be hereditary or an autoimmune disease condition in which neuronal degeneration of the oesophagus occurs. Oesophageal cancer and parasitic infection named Chagas’ disease might be probable causes of Achalasia in some patients (Boeckxstaens, Zaninotto & Richter, 2014).

Achalasia occurs in later stages of life but could also occur among children. Moreover, Middle-aged and older adults are also high risk groups for this disease. Achalasia could also occur in people who are already suffering from some autoimmune diseases. Achalasia is a progressive disease and patients suffering from achalasia would experience a slow decline in eating and drinking over years. In advanced stages, achalasia is responsible for severe weight loss and malnutrition among patients. The underlying causative mechanism of achalasia, which causes failure of normal contraction of oesophageal muscles, is still unknown.

Achalasia is a persistent problem and its symptoms lasts for months or years. In the early stages of the disease, patients experience brief episodes of achalasia exhibited by symptoms such as difficulty in swallowing, regurgitation of undigested food, chest pain, and heart burn. Achalasia is a serious disease and can be debilitating, if left untreated. People with achalasia suffer from considerable weight loss, malnutrition and lung infections such as pneumonia due to aspiration of food (Boeckxstaens, Zaninotto & Richter, 2014).

Diagnosis of Achalasia is performed through some specific tests such as barium swallowing, endoscopy, and Manometry. Barium swallowing test is performed by giving a liquid barium preparation to the patient and its movement is evaluated using an X-ray of the oesophagus. Endoscopy of the oesophagus is also performed by passing a narrow, flexible tube into the oesophagus which projects the images of oesophagus on the screen. Hence, a physician could confirm the closure of LES which is responsible for symptoms of dysphagia. Manometry is another diagnostic test for achalasia which is performed by measuring the strength and timing of esophageal contractions (Boeckxstaens, Zaninotto & Richter, 2014).

The treatment approach used to treat achalasia in the early 20th century was the traditional surgical approach known as Heller myotomy. In this technique, the muscles of the lower oesophageal valves were cut through an open incision of the left side of the chest. In the present scenario, patients suffering from achalasia are treated by minimally invasive surgical incisions known as Laparoscopic esophagomyotomy. This surgical technique performs five small incisions across the chest and the abdomen to minimize gastroesophageal reflux. The success rate of Laproscopic esophagomyotomy is high and two-thirds of patients do not undergo any other treatment. However, some patients also undergo balloon dilation to have long-term results (Familiari, Gigante, Marchese, Boskoski, Tringali, Perri & Costamagna, 2016).

Balloon dilation is a non-surgical treatment in which a gastroenterologist inserts a balloon in the lower oesophageal sphincter and inflates it to widen the opening of LES for food entering into the stomach. The balloon dilation treatment is repeated over years and this non-surgical treatment relieves 75% of achalasia symptoms for years (Familiari et al. 2016).

Patients who cannot undergo surgery and balloon dilation therapy are often treated with botulinum toxin (botox) injections. These injections are made up of bacterial protein and relax spastic muscles of the oesophagus. Botox injections give short-term results to patients and helps in symptom relief. Other medications which are given in achalasia include nifedipine and nitroglycerin which also relieve spasticity of oesophageal muscles. It should be kept in mind that the aforementioned treatments of achalasia do not fix the oesophagus. Medications only improve oesophageal emptying and relieves dysphagia (Familiari et al. 2016).

Specific diet plans are not needed to manage the condition of achalasia but patients generally take foods which are easy to engulf such as liquid foods and carbonated beverages, as these drinks help in pushing the food through the esophageal sphincter. It is already known that achalasia causes weight loss and malnutrition. Hence, it is suggested that patients suffering from achalasia should be given a liquid diet containing all the necessary nutrients to keep up with the daily nutritional demands (Vanuytsel et al. 2012).

Patients suffering from achalasia are instructed to swallow their food thoroughly and drink water during swallowing to provide mucus to the oesophageal tract. These patients should take meals early in the evening and are prohibited to eat near bedtime. They should sleep with their head in a  slightly raised position to avoid food regurgitation. Foods that are avoided in achalasia include citrus fruits, alcohols, chocolate, ketchup and caffeine, as these products encourage oesophageal reflux. Fried and spicy foods are also not allowed to achalasia patients because they irritate the digestive symptoms and may cause vomiting which furthermore worsen the disease symptoms. Foods which are used to relieve the symptoms and prevent patients from malnutrition include soups, porridge, mashed vegetables, and yogurt. Ginger can be given to aid digestion and prevent heartburn. Peppermint tea is also helpful in reducing gastric secretions. Patients are  asked to consume 10 glasses of water daily to stay hydrated (Vanuytsel et al. 2012).

Written for

Empowering People with Invisible Chronic Illness-The EPIC Foundation
12-Dec-2018

Created By
HOI Solutions – Hub Of Innovation

References

Boeckxstaens, G. E., Zaninotto, G., & Richter, J. E. (2014). Achalasia. The Lancet, 383(9911), 83-93.

Familiari, P., Gigante, G., Marchese, M., Boskoski, I., Tringali, A., Perri, V., & Costamagna, G. (2016). Peroral endoscopic myotomy for esophageal achalasia. Annals of surgery, 263(1), 82-87.

Vanuytsel, T., Lerut, T., Coosemans, W., Vanbeckevoort, D., Blondeau, K., Boeckxstaens, G., & Tack, J. (2012). Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia. Clinical Gastroenterology and Hepatology, 10(2), 142-149.