What Is Achalasia?

Achalasia is a disease characterized by dilation of the part of the esophagus (oesophagus) close to the stomach and narrowing of the place where it joins the stomach. This condition prevents food from passing into the stomach and can cause food accumulated in the esophagus to flow back toward the mouth.

What Is Achalasia?

Achalasia is a disorder in which the movements of the esophagus do not occur normally. Peristaltic movements are the rhythmic contractions of the muscles that move food from the esophagus toward the stomach after it is swallowed. In patients with achalasia, these muscles cannot contract or relax sufficiently and peristaltic movements stop. This makes it more difficult for food to pass into the stomach. If achalasia is left untreated, it can lead to serious diseases such as esophageal perforation, aspiration pneumonia and esophageal cancer.

What Causes Achalasia?

Although the exact cause of achalasia is still not fully known, research shows that some factors play a role in the development of the disease. The possible causes of achalasia are:

Nervous system damage: Damage to the nervous system that controls the esophageal muscles may contribute to the development of achalasia. This damage can prevent the muscles in the lower part of the esophagus from contracting and relaxing normally.

Autoimmune disorders: Autoimmune disorders are conditions in which the body's immune system attacks its own tissues. In patients with achalasia, disorders in autoimmune mechanisms may affect the immune system and esophageal muscles and impair normal muscle function.

Genetic factors: In some cases, achalasia may occur among family members, and genetic predisposition may play a role. However, which genes are involved and how they are inherited is still unclear.

Infections: Some research shows that in patients with achalasia, the immune system's response changes in association with infections. In particular, the parasitic infection known as Chagas disease (Trypanosoma cruzi) is recognized as a rare cause of achalasia.

What Are the Symptoms of Achalasia?

Symptoms of achalasia may vary from patient to patient, and their severity may differ from person to person. If you experience any of these symptoms, it is important to consult a gastroenterologist. The symptoms of achalasia can be listed as follows:

Dysphagia (difficulty swallowing): The most common symptom is difficulty moving food toward the stomach due to weakness or failure to relax of the muscles of the esophagus. While swallowing, you may feel food getting stuck, difficulty when food passes through the throat, or a sense of obstruction during passage.

Chest pain: Patients with achalasia usually feel pain or pressure in the chest area. This pain may sometimes be felt as a burning sensation and may increase especially after eating.

Regurgitation: The backward flow of food and liquids from the esophagus is called regurgitation. In patients with achalasia, food coming back up is frequently seen, especially when lying down or immediately after eating.

Gagging: Patients with achalasia may tend to gag because food gets stuck in the esophagus. The gag reflex may be triggered by food returning or getting stuck in the throat.

Weight loss: Due to difficulty swallowing and food coming back up, weight loss is a common symptom in patients with achalasia. Weight loss may occur due to reduced food intake and problems with nutrient absorption.

Chest infections: Achalasia can cause the contents of the esophagus to flow back and accumulate. In this case, the risk of infection in the esophagus increases and recurrent chest infections may occur.

Loss of appetite: Difficulty swallowing, pain and other symptoms can lead to loss of appetite in patients with achalasia. Difficulty and discomfort when food passes through the esophagus can adversely affect appetite.

Who Is at Risk for Achalasia?

Achalasia can occur at any age, but it is generally seen more often in adults. Risk factors for achalasia include the following:

Age: Achalasia can occur at any age, but it is a disease that is generally seen more frequently between the ages of 25 and 60.

Sex: Since sex does not make a difference in achalasia, it can be said that it is seen with equal frequency in men and women.

Family history: In some cases of achalasia, individuals with similar symptoms have been identified among family members. For this reason, it is thought that genetic predisposition may play a role.

Autoimmune diseases: It has been observed that autoimmune diseases (for example, thyroid diseases, rheumatoid arthritis, etc.) are seen more frequently in patients with achalasia. Autoimmune mechanisms may play a role in the development of achalasia.

Infections: An infection caused by the parasite Trypanosoma cruzi, known as Chagas disease, may rarely cause achalasia. However, these infections are generally more common in South and Central America.

Anyone experiencing symptoms of achalasia or who thinks they may be at risk is advised to consult a gastroenterologist to be checked for diagnosis and treatment.

What Methods Are Used to Treat Achalasia?

The goals of achalasia treatment are to relieve symptoms, allow easier passage of food and prevent complications. Regular follow-up and adherence to treatment are important, because achalasia is a chronic condition and may require treatment. Treatment of achalasia is determined together with the doctor depending on the severity of symptoms, the patient's age, general health status and preferences. Treatment options include the following:

Botulinum toxin injection (Botox): Botulinum toxin injections may be given to relax the muscles in the lower part of the esophagus. The injection temporarily relaxes the muscles and may reduce difficulty swallowing. However, since its effect is not lasting, it may need to be repeated.

Dilation (stretching): The lower part of the esophagus can be stretched using endoscopy. A balloon or another device is used to widen the narrowed area, allowing food to pass more easily. For example, balloon dilation for achalasia is among the stretching methods and is effective in controlling symptoms.

Drug therapy: Medications such as nitrates and calcium channel blockers can relieve symptoms by relaxing the muscles of the esophagus. However, drug therapy does not completely eliminate the disease and is generally used together with other treatment methods.

Surgical intervention: If drug therapy and dilation do not give sufficient results, or if complications develop, surgical intervention may be needed. Surgical options include making an incision in the muscles of the lower part of the esophagus (myotomy) or creating a connection between the esophagus and stomach (fundoplication). Surgical treatment generally offers a permanent solution, although it carries some risks.

How Is Achalasia Diagnosed?

The diagnosis of achalasia can be made by a specialist through tests and evaluations. The diagnostic process for achalasia proceeds through the following steps:

Medical history and physical examination: The doctor begins the diagnostic process by listening to your symptoms and medical history. The doctor asks about symptoms such as difficulty swallowing, chest pain and regurgitation, and checks your abdominal area through a physical examination.

Endoscopy: Endoscopy is the procedure of looking inside the esophagus using a flexible tube (endoscope). The endoscope is passed through the mouth and placed into the esophagus and stomach. In this way, the doctor can examine the condition of the muscles in the lower part of the esophagus and detect inflammation or other abnormalities.

Swallowing tests: Swallowing tests are among the methods used to evaluate esophageal movements. Swallowing tests include X-rays taken during swallowing, also known as barium swallow (contrast esophagram), manometry, which measures pressure values in the esophagus, and pH tests. These tests help confirm the diagnosis of achalasia by evaluating the muscle movements, pressures and acid reflux of the esophagus.

Biopsy: In rare cases, a sample (biopsy) may be taken from the inner surface of the esophagus. This sample is examined in laboratory analyses and is performed to rule out other possible causes.

After the diagnosis is made by combining symptoms and test results, appropriate treatment methods can be determined. If you think you are experiencing symptoms of achalasia, it is important to apply to a gastroenterologist or digestive system specialist for a detailed evaluation and diagnosis.

Frequently Asked Questions About Achalasia

Achalasia is a condition in which, beyond nutrition in particular, there are things a person needs to pay attention to in daily life. Questions arise about what to pay attention to when living with achalasia and about the treatment process. Some of the frequently asked questions about achalasia are: Can achalasia be treated with medication? Medication can be used, but drug therapy is generally used to relieve symptoms and provide comfort. Medications such as nitrates and calcium channel blockers try to reduce difficulty swallowing by relaxing the muscles of the esophagus. However, medications do not eliminate the underlying cause of achalasia. Because patients with achalasia have difficulty swallowing, some foods may be hard to pass through the esophagus. It is also recommended to stay away from foods and drinks that may irritate or damage the esophagus. For these reasons, patients are advised to avoid foods and drinks such as large mouthfuls, very hard and dry foods, acidic drinks, alcohol and caffeine, and very spicy and seasoned foods. Pregnancy may place extra pressure on the esophagus and may lead to worsening of symptoms. Symptoms such as dysphagia, chest pain and regurgitation may increase or worsen during pregnancy. Achalasia symptoms may cause inadequate nutrition during pregnancy by making passage of food through the esophagus difficult. Also, some drugs used in achalasia treatment may not be safe during pregnancy. For this reason, it is important to consult your doctor and get information about drug therapy during pregnancy. Since achalasia, if left untreated, can lead to serious diseases such as esophageal perforation, aspiration pneumonia and esophageal cancer, it is important to consult a gastroenterologist if you have symptoms of achalasia.