Achalasia

Achalasia is an esophagus disease. It is difficult to pass the food and fluids to the stomach. Achalasia occurs when there is damage to the nerves feeding the esophagus. As a result, the esophagus loses its ability to feed down the food and the lid between the esophagus and the stomach (lower esophagus sphincter) cannot be completely loosened.

Treatment of achalasia with medication is not very useful. However, symptoms can be treated by balloon dilation endoscopic myotomy (POEM) or surgery.

What are the symptoms of Achalasia?

-Difficulty swallowing food

-Difficulty swallowing both solid and liquid food

-Foods in the esophagus that cannot pass down can escape into the lungs and aspiration pneumonia (severe pneumonia) and shortness of breath can occur.

-Heartburn; The resulting rancidity of food is irritating to the esophagus. Drugs that reduce stomach acid are not useful.

-Loss of weight due to reduced intake of food

Diagnosis

Achalasia may be overlooked or misdiagnosed, as there are complaints similar to other digestive disorders.

The tests your doctor may recommend to demonstrate achalasia:

Esophageal manometry. This test measures rhythmic muscle contractions in your esophagus, coordination and strength of the esophagus muscles, and whether the lower esophagus loosens during swallowing.

X-ray of the esophagus. The esophagus X-ray is the X-ray imaging of the esophagus after a medicated liquid has been ingested. In this way, stenosis and dilations of the esophagus, movements are observed.

Treatment

• Medications: If an early diagnosis is made, the medications may expand the narrowed portion of the esophagus to ensure proper feeding. For example, calcium channel blockers and nitrates can be used.Balloon, or pneumatic, dilation With a small balloon, the lower end of the esophagus is placed and inflated to expand the lower end cap of the esophagus. This may need to be done more than once. Approximately 60 percent of patients receive one balloon therapy for one year, and their effect lasts for about 5 years in about 25 percent. Complications are puncture and chest pain. Balloon expansion also causes reflux in 2% of patients.

  An operation to cut the muscle usually helps to prevent clogging. It has a success rate of 70 percent to 90 percent. Symptom relief will last 10 years in 85 percent of cases and 65 percent of people will relax for 20 years

  Myotomy: An operation to cut the muscle usually helps prevent obstruction. It has a success rate of between 70 percent and 90 percent. Symptom relief will last for 10 years in 85 percent of cases, and 65 percent of people will have relief for 20 years.

  Peroral endoscopy myotomy (POEM): Endoscopically, a tunnel opens in the esophagus wall, then passes through this tunnel, and the inner muscle layer of the esophagus wall is cut. Then the entrance hole is closed with the clips.

  Botox: Injection of botulinium toxin into the lower lid of the esophagus is provided to relax the muscles. This method continues to effect until 4-6 months.Then need to repeat.

  Surgery

  Surgery may be recommended for younger people because nonsurgical treatment tends to be less effective in this group. Surgical options include:

  Heller myotomy. The surgeon cuts the muscle at the lower end of the esophageal sphincter to allow food to pass more easily into the stomach. The procedure can be done noninvasively (laparoscopic Heller myotomy). People who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD).