Achalasia

What is Achalasia?

Achalasia is a rare disease affecting the oesophagus (food pipe) usually diagnosed in young adulthood.

The term means “failure to relax” and this relates specifically to the inability of the muscle at the lower end of the oesophagus to open and let food pass into the stomach.

The condition is also characterised by the muscle in the lower half of the oesophagus being unable to contract properly, making it harder for food to move safely down the tube and into the stomach. This results in food sticking the oesophagus once swallowed and can be uncomfortable and even dangerous.

What Causes Achalasia?

There is no known cause of achalasia. There are theories and suggestions it could be caused by infection, could be genetic or could even be caused by an abnormality within the immune system. Unfortunately, to date, none of these theories has been proven.

Symptoms of Achalasia

The most common symptoms of achalasia are difficulty in swallowing, and this can in turn result in regurgitation of food which has been trapped in the oesophagus. Some patients suffer from chest pain and when food is regurgitated it can lead to uncomfortable coughing and in extreme cases, can lead to breathing problems as the food enters the throat or lungs when regurgitated.

Diagnosing Achalasia

Achalasia can be diagnosed in several ways. Often patients will have an x-ray study which involves taking videos of the oesophagus after barium is swallowed. The barium fills the oesophagus and as it exits the stomach it can be watched. Patients with achalasia will show the oesophagus as widened but tapers to narrower at the lower end and the barium will also take longer than average to pass into the stomach.

Patients may also have a test called the oesophageal manometry, which can demonstrate abnormalities in the muscle function of the oesophagus characteristic of achalasia. To carry out a manometry a thin tube measuring the pressure generated in the contraction of oesophageal muscle is passed through the nose into the oesophagus. In patients with the condition no wave of pressure due to muscular contraction is seen in the lower half of the oesophagus when swallowing.

Endoscopies can also be used to examine and diagnose achalasia, as this type of procedure provides direct visualisation of the oesophagus.

Treating Achalasia

The symptoms of achalasia can be managed with oral medication, through stretching the lower oesophageal sphincter and in some cases surgery to cut the sphincter. Treatments such as the use of botulinum toxin, commonly recognised as Botox, into the sphincter which can help to loosen the muscle but are used very infrequently now and often do not work or need to be repeated.

Oral medications for achalasia include nitrates and calcium-channel blockers. They are usually not enough on their own to manage the disease.

Treating the lower oesophageal sphincter directly is popular as it can instantly relieve many symptoms. Common treatments include using endoscopy to position a balloon into the sphincter to help it to stretch and dilate the muscle and help it work more effectively.  A newer and far more effective treatment is to use the endoscope to create a tunnel in the layers of the oesophagus and to cut the muscles away that way – this is a minimally invasive procedure called (POEM) and does not need surgery and is very safe.

Appointments with Dr Haidry

Dr Rehan Haidry is an experienced Consultant Gastroenterologist who can help talk through your options as someone living with achalasia or diagnose the condition should you be experiencing symptoms you’re worried about.

To make an enquiry or appointment please contact Dr Rehan Haidry's secretary