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Achalasia is a rare disorder that affects the food pipe (esophagus), where the muscles at the lower end of the food pipe are constricted. This makes it difficult for the swallowed food to enter the stomach, causing regurgitation of the food back into the mouth. Only liquids can pass through the constricted food pipe in Achalasia. The symptoms of achalasia appear gradually and worsen with time. Timely diagnosis and the right kind of treatment ensure it is possible to manage the symptoms of achalasia and lead a good life.
The food that we chew is pushed into the esophagus after being swallowed. There is a muscular ring called the Lower Esophageal Sphincter at the lower end of the esophagus, where it connects to the stomach. When food approaches this sphincter, it relaxes and opens, allowing food to travel into the stomach. After the food has been consumed, it shrinks and closes. In Achalasia, the sphincter does not open; the food cannot reach the stomach and remain in the esophagus. It becomes challenging for the esophagus to push food down because its muscles are also impaired.
People with achalasia often fall into the 30 to 60-year age range. Men experience this disease two times more frequently than women.
Though it is well-established that achalasia happens due to the inability of the esophageal sphincter to relax, it is not known what exactly causes it. Several theories are put forth by scientists.
The symptoms of achalasia are mainly due to food piling up inside the esophagus. The piled-up food distorts the shape of the esophagus and widens it. This leads to abnormal contractions of the esophagus, resulting in different symptoms. The symptoms occur while eating or after you have finished eating. They include-
A thorough medical examination, including your personal and family history, will help your doctor establish a diagnosis. He may suggest the following tests for confirmation-
The treatment options available for Achalasia aim to improve the motility of food through the esophagus. You may need repeated sessions of some form of treatment. The treatments relieve the symptoms to a great extent but do not cure you completely. Treatment options include:
Non-surgical
Pneumatic Dilation- The esophageal sphincter is first dilated with a unique procedure, after which a specific bowl is introduced. Because of this, food can travel easily into the stomach and widens the lower esophageal aperture. Perforation, a rare danger associated with this medication, may occur and necessitate surgery .
Botox Injections- Injections of botulinum toxin are used in this technique. This poison works by inhibiting the neurons that contract the sphincter. By keeping the sphincter relaxed and dilated, food can pass through. Botox injections have quick but transient responses. You may need to schedule more sessions every six months to a year.
Medication- Certain medications can be tried when surgery is to be avoided. The medicines act in various ways to help the esophageal sphincter to relax. These medicines include-
Surgical- This procedure is known as Laparoscopic Surgical Myotomy. In this procedure, the lower esophageal sphincter muscles are cut to relax and allow the food to pass. This surgery is done under general anesthesia. It is a minimally invasive procedure done using laparoscopes or robotic techniques.
This surgery has a high success rate.
The complications of achalasia are mainly due to the regurgitated food being aspirated into the trachea and lungs. The complications include:
Suffering from achalasia increases your risk of developing esophageal cancer.
Achalasia is a lifelong condition that has no cure. Understanding the disease condition fully is important to set realistic expectations for living with achalasia. Lifestyle modifications help to control the symptoms of achalasia and can slow down their progress. Some of the lifestyle changes that you can incorporate include-
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