Achalasia
Achalasia, also known as oesophageal achalasia, is a condition in which the oesophagus (a tube that carries food from the mouth to the stomach) is unable to move the food into the stomach. Lower oesophageal sphincter is a ring of muscle fibres that surrounds the lower-most end of the oesophagus where it joins the stomach. LES acts like a valve between the oesophagus and stomach, preventing food from moving backwards into the oesophagus. In people with achalasia, the LES fails to relax during swallowing, resulting in the food moving backwards into the oesophagus. The oesophagus itself has disordered motility and is unable to propel the food forward properly.
Symptoms of Achalasia
The main symptoms of achalasia include difficulty in swallowing (dysphagia), regurgitation of food, heartburn, weight loss, chest pain, and cough.
Diagnosis of Achalasia
Your doctor may order the following tests to diagnose achalasia:
Barium swallow test: The test involves swallowing a barium preparation while X-rays are taken. The barium coats the walls of the oesophagus and stomach and makes the abnormalities visible more clearly.
Endoscopy: This test allows the doctor to examine the inside of the patient's oesophagus, stomach, and portions of the intestine, with an instrument called an endoscope, a thin, flexible, lighted tube.
Manometry: It is a test that measures changes in pressure exerted by the oesophageal sphincter.
Treatment Options for Achalasia
Treatment options for achalasia include:
- Medications: Medications such as nitrates and calcium channel blockers are recommended to relax the lower oesophagus sphincter.
- Botox: Botulinum toxin injection can be administered to help relax the sphincter muscles
- Balloon dilation (pneumatic dilatation): A small balloon is positioned at the LES and inflated in order to widen the opening for food to enter the stomach.
- Myotomy: POEM (per oral endoscopic myotomy). This is an incisionless or scar less procedure where the muscle can be cut on your oesophagus with no external incisions.
- Laparoscopic Heller’s myotomy: This is a keyhole operation where the muscle again is divided on the lower oesophagus and a fundoplication may also be performed.
Depending on your condition your doctor will decide which treatment is right for you.