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Achalasia: When food can't make it to the stomach

The symptoms of achalasia come on slowly, making swallowing increasingly difficult. Chest pains and digestion problems can develop as food piles up above the stomach. Luckily, treatment can help.

Achalasia is an unusual condition that affects the muscles of the esophagus, the tube that leads from the mouth to the stomach.

The esophagus is lined with muscles that tighten and relax to move food toward the stomach. At the end of the esophagus, a muscular valve opens to let food pass into the stomach.

Achalasia develops when these muscles lose their ability to relax, so food doesn't move down the esophagus normally and the valve at the bottom of the esophagus stays closed, preventing food from entering the stomach.

The condition is usually diagnosed in adults, according to the National Institutes of Health (NIH). However, it can affect children as well.

Currently, the cause of achalasia isn't known.

Symptoms and diagnosis

According to the NIH and the Society of Thoracic Surgeons, the symptoms of achalasia include:

  • Difficulty swallowing.
  • Pain or discomfort in the chest, sometimes related to eating.
  • Regurgitating undigested food.
As the disease progresses, swallowing tends to become increasingly difficult, and a bad taste in the mouth or bad breath can also develop. Eventually, someone with achalasia may find it hard to swallow even liquids. Because food isn't getting into the stomach, the person may start losing weight and could develop a shortage of important nutrients. Achalasia can also lead to weight loss and pneumonia.

How is it found?

If someone's symptoms suggest achalasia, a doctor may order tests, such as:

Chest x-rays to look for changes in the shape of the esophagus. A barium solution, which shows up on x-rays, is swallowed before the image is taken. This test shows the action of the muscles in the esophagus.

Endoscopy to see inside the esophagus. This test uses an endoscope—a long, flexible, narrow tube with a light and tiny camera on the end of it. The endoscope is passed through the mouth and down the esophagus so the doctor can see inside of it.

An endoscope can also be used with manometry, a test that measures pressure changes in the esophagus, showing if the muscles are tightening and relaxing normally.

Treatment

Achalasia cannot be cured, but several treatments can help relieve the symptoms.

One treatment, according to the NIH, is taking medicines called calcium channel blockers to help relax the muscles in the esophagus.

A longer-term solution involves threading an endoscope with a small, balloonlike device on its tip down the throat to the valve between the esophagus and stomach. The balloon is expanded, opening the muscles to create a pathway for food.

An endoscope can also be used to inject Botox into the valve. This toxin paralyzes the muscles that control the valve so they can't tighten and close off the path to the stomach.

Surgery can also be done to cut the muscles of the valve between the esophagus and stomach, creating a permanent opening.

Some of these treatments need to be repeated, and others can increase the risk of other digestive problems. Treatment decisions can also be affected by a person's age and overall health as well as by the severity and duration of symptoms.

reviewed 10/6/2019

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