Achalasia - Symptoms, causes and treatment

Achalasia is a condition when the muscles of the esophagus are unable to push food or drink into the stomach. This condition is characterized by difficulty swallowing, and sometimes food back up into the throat.

When a person eats or drinks, the muscles at the bottom of the esophagus (lower esophageal sphincter/LES) will contract to push food or drink deeper. Next, the ring of muscle at the end of the esophagus relaxes to allow food or drink to enter the stomach.

In patients with achalasia, the LES becomes stiff and the muscle rings do not open. As a result, food or drink accumulates at the bottom of the esophagus and sometimes back up to the top of the esophagus.

Achalasia is a rare disease. It is estimated that this condition occurs in 1 in 100,000 people. However, this disease can affect people of all ages, both men and women.

Causes of Achalasia

It is not known what causes achalasia, but it is suspected that achalasia is related to the following conditions:

  • Autoimmune disease
  • genetic factors
  • Decreased nerve function
  • viral infection

Symptoms of Achalasia

Symptoms of achalasia appear gradually. Over time, the function of the esophagus will become weaker and the following symptoms may appear:

  • Often burp
  • Difficulty swallowing or dysphagia
  • Weight loss
  • Food back up into the esophagus or regurgitation
  • heartburn (heartburn)
  • Chest pain that comes and goes
  • Cough at night
  • Throw up

When to go to the doctor

Immediately see a doctor if you experience the above symptoms. If left untreated, untreated achalasia can increase the risk of the sufferer developing esophageal cancer.

If you've been diagnosed with achalasia, talk to your doctor or nutritionist about proper diet. You should also see a doctor if you are still experiencing symptoms, even though you have received medical treatment.

The symptoms of achalasia are similar to the symptoms of other digestive disorders, such as GERD. By seeing a doctor, you will get the right treatment.

Achalasia Diagnosis

To make a diagnosis, the doctor will first ask about the patient's symptoms and medical history. After that, the doctor will perform a physical examination of the patient's ability to swallow food or drink.

Furthermore, the doctor may perform additional examinations, such as:

  • Esophagography, to get a detailed picture of the esophagus, stomach and intestines by drinking Barium liquid
  • Manometry, to measure the flexibility and strength of the muscle contractions of the esophagus when swallowing
  • Endoscopy, to examine the condition of the walls of the esophagus and stomach

Achalasia Treatment

Acalasia treatment aims to relax the LES muscle, so that food and drink can enter easily into the stomach. The method of treatment can be non-surgical or surgical. Here's the explanation:

Non-surgical procedures

A number of nonsurgical procedures that can be performed to treat achalasia are:

  • Pneumatic dilation

    This is a procedure to widen the esophagus by inserting a special balloon into the narrowed part of the esophagus. This procedure needs to be done repeatedly to get the best results.

  • Inject botulinum toxin

    Inject botulinum toxin (Botox) serves to relax the esophageal muscles for patients who cannot undergo surgery pneumatic dilation. The effect of botox injections only lasts a maximum of 6 months, so the procedure needs to be repeated.

  • Administration of muscle relaxants

    The drugs used include nitroglycerin and nifedipine. Muscle relaxants are given to patients who cannot undergo pneumatic dilation or surgery, or when Botox injections are not effective in treating achalasia.

Surgical procedure

Some surgical procedures that doctors can choose to treat achalasia are:

  • Heller myotomy

    This is an act of cutting the LES muscle using a laparoscopic technique. Heller myotomy can be performed concurrently with the procedure fundoplication to reduce the risk of future GERD attacks.

  • Fundoplication

    Fundoplication is the act of wrapping the lower part of the esophagus with the upper part of the stomach. The goal is to prevent stomach acid from rising into the esophagus.

  • Oral endoscopic myotomy (POEM)

    POEM is a procedure that cuts the LES muscle directly from the inside of the mouth. This procedure is performed with the help of a camera tube that is inserted through the mouth (endoscope).

Achalasia Complications

Achalasia left untreated can lead to a number of complications, including:

  • Aspiration pneumonia, which occurs due to the entry of food or drink into the lungs, causing infection
  • Esophageal perforation or tearing of the patient's esophagus (esophagus) wall
  • Esophageal cancer

Achalasia Prevention

Achalasia is difficult to prevent, but if you have achalasia, there are several things you can do to prevent complaints or symptoms from appearing, namely:

  • Drink more water while eating
  • Chew food until it is completely smooth before swallowing
  • Avoid consumption of foods or drinks that can trigger heartburn (heartburn), such as chocolate, citrus, and spicy food
  • Eat small portions but often, rather than eating infrequently but at the same time eating large portions
  • Avoid eating at night, especially if it is close to bedtime
  • Supporting the head with a pillow while sleeping, to prevent stomach acid from rising into the esophagus
  • Do not smoke