Everyone Healthy Library
Achalasia
Also Known As: Cardiospasm
Condition / disease reference page from the Everyone Healthy database.
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Connected health information
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Condition overview
Attributes
Commonalityis rare
Incidenceis approximately 1 in 100,000 people
Linked signs and symptoms
4Each sign/symptom opens its own page and links back to related conditions.
Linked drugs / medications
0No linked drugs are listed yet.
Treatments, therapies and supportive options
6Grouped by treatment type. These are educational database links, not personal treatment recommendations. Evidence labels are shown only where stored in the EH database.
Linked diagnostic tests and investigations
7These are pulled from both EH diagnostic-test link tables, including the older large test-link table.
Biological markers/agents
0This visual map shows biological markers/agents reported as increased or decreased with this condition. These are educational relationships only; test results must be interpreted by a qualified clinician because ranges vary by lab, method, age, sex and clinical context.
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Introduction / full article
Achalasia
Achalasia
Achalasia is a rare oesophageal motility disorder, in which the muscle layer of the oesophagus loses the ability to move food downwards (aperistalsis). Further, the lower oesophageal sphincter (LOS) is unable to relax properly, preventing swallowed food from entering the stomach.
Causes
Achalasia is caused by the degeneration of neurons in the oesophagus. This phenomenon is, in itself, idiopathic, but several possible causes have been proposed, and include:
· Infection;
· Autoimmune disease; and
· Genetic inheritance.
Disease pathway
The muscle of the lower oesophagus – around the nerves in particular – becomes inflamed.
The affected nerves degenerate, and eventually disappear. This damage also causes the surrounding muscle to degenerate.
As a result, the LOS loses the ability to relax, and the muscle layer cannot produce peristaltic waves.
Over time, lack of use will see the oesophagus stretch and become dilated.
Symptoms and diagnosis
The most prominent symptom of achalasia is difficulty in swallowing both solids and liquids (dysphagia), which becomes progressively worse with time. Other symptoms are also common, such as:
· Coughing when reclined, caused by food remaining the oesophagus;
· Chest pain due to the pressure of undigested food against the LOS;
· Regurgitation; and
· Weight loss and malnutrition.
A test designed specifically for achalasia is barium swallow, in which a barium sulphate solution is administered to the patient. X-ray images are taken to track the descent of the solution through the oesophagus, and information regarding the state of the system can be obtained.
Oesophageal manometry involves the insertion of a thin tube through the patient’s nose. The patient is instructed to swallow several times, and the highly-sensitive probe measures the extent of contractions in parts of the oesophagus during this process.
Treatment
Heller myotomy is a surgical procedure in which the muscles adjacent to the LOS are cut, enabling ingested foods and liquid to pass to the stomach.
Botox injections into the sphincter can also paralyse the muscles holding it shut, although this effect is only temporary. It is sometimes used to buy time while awaiting surgical treatment.