Achalasia: causes, symptoms and treatment options

45

Achalasia is a health condition that can affect the quality of life of affected individuals; therefore, it is of fundamental importance to have knowledge about the subject and know how to deal with the problem.

Discover the causes, symptoms, and treatment options for achalasia, a disorder of the esophagus that causes difficulty in swallowing. Read more here! 

What is achalasia?

Achalasia is a rare disease of the digestive system that affects the ability of the esophagus to perform adequate peristaltic movements and properly relax the lower esophageal sphincter (LES) during swallowing. 

This condition leads to a series of problems in the process of passing food and liquids from the esophagus to the stomach, resulting in symptoms such as difficulty swallowing (dysphagia), regurgitation, chest pain,  heartburn and weight loss.

The esophagus is a muscular organ that transports food from the throat to the stomach through coordinated muscle contractions, called peristalsis. 

However, in achalasia, there is a deterioration of the nerve cells that control these contractions, resulting in an inability of the esophagus to properly push food.

The LES, located at the lower end of the esophagus, also does not relax properly during swallowing, thus preventing the proper passage of food to the stomach, which accumulates in the esophagus, leading to dilation (increase) of the organ.

This disease is chronic and can be progressive over time. 

Because of this, proper diagnosis and treatment are essential to control symptoms and improve the quality of life of patients suffering from the situation.

Causes of achalasia

Achalasia is divided into primary and secondary. The primary, or idiopathic is the one in which its cause cannot be identified. In the secondary, achalasia has a defined cause, such as collagen diseases (rheumatic diseases) and in Brazil, mainly, Chagas disease. 

Today we are going to talk about primary achalasia.

Although the exact causes of the disease are not fully understood, researchers have made significant progress in identifying the factors that may contribute to the development of this condition.

One of the main theories about the causes of achalasia involves problems in the nervous system. 

It is believed that an autoimmune disorder may be associated with the degeneration of the nerves that control the peristaltic movements of the esophagus and the opening and closing of the lower esophageal sphincter.

In addition, studies suggest a possible genetic predisposition, which means that the disease can be inherited from an affected family member.

Another hypothesis is that viral or bacterial infections, such as the herpes simplex virus, may trigger an autoimmune response that results in the deterioration of the nerves involved in esophageal function.

On the other hand, some researchers also suggest that certain environmental factors, such as exposure to toxic substances or pollutants, may play a role in the manifestation of the disease.

Although knowledge about the causes of achalasia has advanced, there is still much to be discovered.

Continuing research in this area has been fundamental to improving existing treatments and helping to prevent the development of this debilitating condition.

Symptoms of achalasia

Achalasia can cause several uncomfortable symptoms, the main ones being:

Dysphagia

The difficulty in swallowing is one of the most common symptoms of the disease.

Patients may feel that food or liquids get stuck in the middle of the chest, in addition to the sensation of difficulty in conducting them to the stomach.  

This can lead to frequent choking and a persistent sensation of obstruction in the throat.

Regurgitation

Regurgitation is one of the most common characteristics of those dealing with the condition, and occurs when the content of the esophagus, which is accumulated, returns to the mouth, generating a bitter or acidic taste. 

This reflux can be inconvenient and unpleasant, and can occur especially after meals.

Chest pain

Many patients report chest pain, which can be mild or intense, and is usually felt shortly after meals or during the ingestion of liquids.

Weight loss

As the difficulty in swallowing can lead to reduced food intake, some patients experience significant weight loss and need nutritional attention to manage the situation of exaggerated loss.

Constant feeling of fullness

The feeling that food gets stuck in the esophagus can lead to a constant feeling of fullness, even after small meals, which can lead to the patient’s weight loss, who stops eating properly because of this symptom.

Cough and frequent pneumonias

The regurgitation of the contents of the esophagus can lead to the aspiration of food or liquids into the lungs, resulting in chronic cough or recurrent pneumonias.

Although it is not a frequent symptom or that appears with accuracy in all cases, it should be taken into consideration since its occurrence is not discarded.

It is important to highlight that achalasia is a condition that requires adequate medical attention. 

Symptoms can worsen over time, causing significant impacts on the patient’s quality of life. 

Therefore, if someone presents these symptoms persistently, it is essential to seek guidance from a health professional for an adequate diagnosis and appropriate treatment.

Treatment options for achalasia

The treatment of achalasia aims to relieve symptoms and improve the patient’s quality of life. 

There are several therapeutic options available, each with its advantages and limitations, and the choice of the most appropriate treatment will depend on the patient’s individual profile and conditions.

One of the options is esophageal dilation, a minimally invasive procedure performed through endoscopy. 

In this method, a balloon is inflated in the esophagus to stretch and widen the narrowed region, allowing better food flow. 

Another alternative is the injection of botulinum toxin into the lower esophageal sphincter, which temporarily relaxes the muscle, facilitating swallowing.

Laparoscopic surgical myotomy is a more definitive option, in which the sphincter is cut or partially removed, improving the emptying of the esophagus. 

This intervention presents good long-term results, but also involves surgical risks.

Recently, an innovative endoscopic approach called POEM (Submucosal Layer Endoscopic Myotomy) has emerged, in which a tunnel is created in the esophageal wall to reach the sphincter and perform the myotomy, with less impact on the patient and faster recovery.

In cases of high surgical risk, pharmacological therapy may be considered to reduce symptoms and improve food passage. 

The use of calcium channel blockers and nitrates can help relax the lower esophageal sphincter.

It should be noted that the choice of treatment will be determined by the severity of the disease, the patient’s general health condition and individual preferences, therefore, it is essential that the doctor evaluates each case in a personalized way to ensure the best possible result. 

It is also important that the patient follows the appropriate medical follow-up to monitor the progression of the disease and adjust the therapeutic approach as necessary.

How to deal with the difficulty in swallowing caused by achalasia?

Dealing with the difficulty in swallowing caused by achalasia can be challenging, but there are some strategies that can help alleviate symptoms and improve quality of life. 

It is important to note that these do not replace proper medical guidance and follow-up. Always consult a health professional for a correct diagnosis and a personalized treatment plan. 

Here are some tips that may be useful:

Changes in diet

Eating small portions of food and chewing them well can help facilitate swallowing.

Opt for soft and easy-to-swallow foods, avoiding those that may cause obstruction, such as dry or very fibrous foods.

Drink liquids

Drinking liquids during meals can help push food down and reduce the sensation of blockage in the esophagus.

Proper posture

Stay in an upright position during and after meals, as this can facilitate the passage of food through the esophagus.

Avoid eating before bed

Try to have your meals with an adequate interval before going to bed to avoid food getting stuck in the esophagus during sleep.

Elevation of the head of the bed

If achalasia causes nighttime symptoms, raising the head of the bed can help reduce acid reflux and alleviate the sensation of obstruction.

Always remember to follow your doctor’s recommendations and inform him about any changes in symptoms or new problems that may arise. 

In summary, although achalasia can be a challenge for both patients and health professionals, hope lies in current and future therapeutic approaches, as well as in awareness about the disease and its early diagnosis. 

With continuous efforts in medical research and proper care like these that you found here, we can provide a better quality of life and a more peaceful future for those facing the challenges of the disease.

Image by brgfx on Freepik