What is Achalasia?
Achalasia is a condition that affects the innervation of the esophagus and the lower esophageal sphincter. The lower esophageal sphincter is a muscle located between the esophagus and the stomach, responsible for relaxing and allowing the passage of food to the stomach. This condition affects the ability of the esophagus to move food and liquids from the throat to the stomach. It is caused by a failure in the relaxation of the lower esophageal sphincter, the muscle located between the esophagus and the stomach, which normally opens to allow the passage of food and then closes to prevent reflux. This leads to a persistent blockage in the passage of esophageal content to the stomach, which can cause dilation of the esophagus, known as megaesophagus.
How does it happen?
Achalasia can be idiopathic (without a specific cause), or secondary, usually due to Chagas disease. This condition leads to abnormal contractions of the lower esophageal muscle, resulting in the inability to adequately relax the esophageal sphincter. As a result, food and liquids have difficulty passing through the esophagus, causing symptoms such as difficulty swallowing, regurgitation, and chest pain.
How is the diagnosis made?
The diagnosis of achalasia is made through several tests, including:
- Esophageal manometry: It is the main exam to confirm the diagnosis. It measures the pressures and muscle movements of the esophagus to assess contractions and function of the lower esophageal sphincter. It is a specialized exam that allows detecting changes in esophageal function even before dilation occurs.
- Contrasted radiography: It is an imaging exam that uses a radiopaque contrast to visualize the esophagus. It can show a dilation of the esophagus due to the accumulation of food.
- Endoscopy: It can be performed to rule out other conditions that may cause similar symptoms, such as tumors or strictures of the esophagus.
How is the treatment done?
The treatment of achalasia is aimed at relieving symptoms and improving the flow of food through the esophagus. Initially, liquid and pasty diets may be useful to facilitate the passage of food. Some medications may be prescribed to relax the lower esophageal sphincter and aid in swallowing.
Treatment options include:
- Esophageal dilation: It is a procedure in which a balloon or dilator is inserted into the esophagus to stretch and expand the lower esophageal sphincter. This helps to improve the flow of food.
- Botulinum toxin injection: Botulinum toxin can be injected into the lower esophageal sphincter to relax the muscles and improve the passage of food.
- Endoscopic myotomy (POEM): The procedure involves cutting the muscles of the lower esophageal sphincter, allowing food to pass more easily to the stomach.
- Surgery: In more severe cases or when other treatments are not effective, surgery may be considered. The goal is to reduce the pressure on the lower esophageal sphincter or perform a myotomy, which is the surgical division of the muscle to allow better flow.
Conclusion
Achalasia is a condition that affects the ability of the esophagus to move food to the stomach due to a problem in the relaxation of the lower esophageal sphincter. The diagnosis is made through tests such as esophageal manometry and barium radiography. The treatment includes esophageal dilation, botulinum toxin injection, and surgery. The goal is to improve the flow of food and relieve symptoms associated with obstruction. It is important to seek medical follow-up for an accurate diagnosis and an appropriate treatment plan.