Definition
Achalasia is a disorder of the motility of the esophagus.
This condition is characterized by an altered esophageal peristalsis and the failure to release the lower esophageal sphincter (muscular valve located between the esophagus and the stomach) during swallowing. As a result, achalasia makes it difficult for food to pass along the esophagus.
Achalasia is due to an alteration of the nerves that control the esophageal smooth muscle. It has been observed, in fact, that people suffering from this disorder have a decrease in the fibers and nerve cells that surround the esophagus. This phenomenon causes an insufficient sending of stimuli. For this reason, the esophagus remains contracted, preventing swallowing.
The exact etiology of achalasia is not yet known. Sometimes, the disorder can be found in association with esophageal tumors and some infections, as in the case of Chagas disease.
Achalasia can occur at any age, but usually begins between 20 and 60 years.
Most common symptoms and signs *
- aphagia
- Halitosis
- Anemia
- Anorexia
- Retrosternal burning
- Heartburn
- Dysphagia
- Chest pain
- Pain in the upper part of the abdomen
- Belching
- Nausea
- Knot in the throat
- odynophagia
- Weight loss
- Heaviness in the stomach
- Hoarseness
- Acid regurgitation
- Intense salivation
- Sense of suffocation
- Cough
- He retched
Further indications
The onset of esophageal achalasia is insidious and progression occurs gradually over months or years.
The first symptoms are represented by an increasing difficulty in swallowing solid and liquid foods (dysphagia) and by regurgitation of undigested food material. This results in sialorrhoea (excessive salivation), halitosis, heartburn (retrosternal burning), frequent eructations and a sense of suffocation.
Regurgitation of undigested food can cause coughing and aspiration in the bronchopulmonary tree (pneumonia ab ingestis). Chest pain is less frequent, but can occur at the time of swallowing or spontaneously. Over the years, achalasia involves weight loss, anemia and malnutrition.
With the progression of the disease, the esophagus can deform, lengthening or dilating. Possible complications of achalasia include gastroesophageal reflux disease and esophagitis.
Diagnosis is generally defined by radiographic studies with barium, endoscopy and esophageal manometry.
Botulinum toxin injections and some drugs (such as nitroderivatives and calcium antagonists) can be used temporarily for mild or moderate cases of esophageal achalasia. Alternatively, endoscopic therapy (esophageal dilation with a balloon) and some surgical procedures (such as Heller's myotomy, an operation that involves the dissection of the muscular layer at the base of the esophagus) may be indicated.
Patients with achalasia also have a slight increased risk of developing neoplastic processes at the esophagus level. Therefore, the doctor may periodically recommend endoscopic checks for the prevention and early diagnosis of esophageal cancer.
