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Esophageal achalasia is a rare disorder that prevents the muscles of the esophagus from relaxing properly, causing difficulty in swallowing and a variety of digestive symptoms. It can be treated with medications or surgery, including calcium channel blockers and botulinum toxin, but surgery is a more permanent solution.
Esophageal achalasia is a rare disease that prevents the muscles of the esophagus from relaxing properly. People with achalasia have trouble swallowing because food can’t pass easily from the esophagus to the stomach. The disorder causes a variety of digestive symptoms and can be treated with medications or surgery.
The main feature of this swallowing disorder is that the sphincter muscle of the esophagus is unable to relax. The sphincter is a ring of muscle located at the junction of the esophagus and stomach. When functioning properly, the muscle relaxes during swallowing to allow food to pass into the stomach and remains contracted at other times to prevent the regurgitation of stomach acid and digested food back into the esophagus.
The inability of the sphincter muscle to relax and contract at the appropriate times can cause a variety of gastric effects. Symptoms of this disorder include regurgitation of food or stomach acid, heartburn, cough, and chest pain. Complications such as pneumonia can occur if stomach contents are regurgitated into the airways.
Achalasia can be caused by parasitic infections, various types of cancer, or traumatic injury to the esophageal nerves. Certain genes may also increase an individual’s susceptibility to developing this disorder. Treatment of achalasia focuses on relaxing the esophageal sphincter muscle to make swallowing easier. Treatment options include several types of medications and a surgical procedure. These treatments have similar results, but surgery is a more permanent fix than medication.
The main therapeutic options for this swallowing disorder are calcium channel blockers and botulinum toxin. Calcium channel blockers are used because they reduce the power of muscle contractions. This reduces the strength of the sphincter contraction and makes swallowing easier. Botulinum toxin, also known as Botox®, can be used as a treatment because this toxin, when injected into the sphincter, paralyzes the muscle and prevents strong contractions.
Both of these medications provide only temporary relief from symptoms. Calcium channel blockers may only be effective for a few months, as many people develop tolerance to the drugs. Botulinum toxin has fewer side effects, but repeated treatments are required every six months. Additionally, the toxin can cause muscle scarring, which can lead to complications if surgery is attempted later.
Achalasia surgery is an option for people who don’t respond well to medications or who prefer lifelong treatment over a short-term series of medications. The surgery is called a Heller myotomy or esophagomyotomy. In this procedure the sphincter muscle is cut so that the muscle can relax properly and allow for normal swallowing. Patients must be in good physical health to have the surgery, as the procedure is difficult and recovery can be stressful.
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