Achalasia

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What is Achalasia?

Achalasia is a disorder of the oesophagus (the tube that carries food from the mouth to the stomach). The oesophagus is less able to move food toward the stomach and the valve from the oesophagus to the stomach does not relax as much as it needs to during swallowing. This relaxation is needed to allow food to enter the stomach. To the right is a picture of the gastroesophageal junction valve between the stomach and the oesophagus that usually relaxes to allow the passage of food, and then closes so that food cannot 'reflux' back out. As seen in this image (taken with an endoscope - a camera that looks down the throat) the sphincter is very tightly closed and thus would not adequately allow the passage of food.

Who gets Achalasia?

It affects men and women equally between the ages of 30-60. It can also occur in infancy and childhood. The incidence is 1 in 100,000/year.

Predisposing Factors

Most commonly the cause is unknown (idiopathic). However, Achalasia can also develop as a result of damage to the nerves to the oesophagus. This is seen in chronic Chagas disease - a condition common in South America which is caused by the Trypanosoma cruzi parasite.

Progression

Achalasia is a progressive disease meaning patients will gradually develop increasing severity of difficulty when swallowing. Medical treatment may alleviate symptoms but they do not provide a long term solution. Most patients require surgical intervention. Those who are treated early (before marked dilation) may avoid complications of oesophageal ulceration, oesophageal candidiasis, and aspirating stomach contents into the lung. There is also a slight increase in the risk of oesophageal carcinoma (cancer of the oesophagus). With successful myotomy (surgery dividing the abnormal muscle in the lower sphincter of the oesophagus), patients are able to gain weight and lead a normal life. Some will develop gastro-oesophageal reflux, especially after surgery which responds to medical treatment. Some recommend endoscopic monitoring for the increased risk of oesophageal carcinoma.

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