What is Achalasia?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Achalasia?
Achalasia is a rare condition in which the esophagus (food pipe) is unable to move food and liquids into the stomach.
The esophagus is a tube that carries the food from the throat region to the stomach. A muscular ring known as the lower esophageal sphincter (LES) closes off the esophagus from the stomach. In the case of achalasia, the LES fails in opening up during swallowing. This causes the backup of food within the esophagus. The achalasia condition is related to the damaged nerves in the esophagus. It can also occur due to the damage of the LES. In today’s article, we will be discussing achalasia in detail –
- What are the causes of Achalasia?
- What are the risk factors of Achalasia?
- What are the symptoms of Achalasia?
- What are the complications of Achalasia?
- How to diagnose Achalasia?
- What is the treatment of Achalasia?
- How to care after surgery for Achalasia?
- What are the risks of the treatments for Achalasia?
- How to prevent Achalasia?
- What is the cost of Achalasia treatment in India?
What are the causes of Achalasia?
The exact cause of achalasia is unknown. However, it is thought to occur due to the following causes:
- Autoimmune disorder (the body attacks itself)
- Hereditary condition
- Viral infection ( Know more about- How does Herpes Infection Spread? )
- Neurodegeneration (loss of the nerve function)
What are the risk factors of Achalasia?
Achalasia can occur in all races and is seen equally in men and women. Certain factors increase the risk of developing achalasia and may include:
- Commonly seen between 30 to 60 years of age, although can be seen in children
- An individual having Down Syndrome (a genetic disorder that may cause physical and developmental problems)
What are the symptoms of Achalasia?
The symptoms of achalasia may include:
- Trouble in swallowing (dysphagia)
- Regurgitation (action of bringing back the swallowed food into the mouth again) of undigested food ( Know more about- What are the causes of Acid Reflux? )
- Cough at night
- Heartburn (burning sensation at the center of the chest)
- Malnutrition or unintentional weight loss due to difficulty in eating
- Hiccups
- Difficulty belching (burping)
- Vomiting
What are the complications of Achalasia?
The complications can occur due to regurgitation of the undigested food into the esophagus, and then being drawn into the windpipe (trachea), which can lead to the lungs. These complications are:
- Lung (pulmonary) infections
- Pneumonia
- Other complications could include:
- Esophageal cancer ( Know more about- What is Esophageal Cancer Treatment? )
How to diagnose Achalasia?
The doctor will first ask you about your symptoms, any pre-existing medical history, or family history of the patient. The doctor may recommend the following tests to confirm the diagnosis of achalasia:
- Barium swallow: A barium preparation (in liquid or other forms) is swallowed and its movement through the esophagus is evaluated by using x-rays. The barium swallow shows the esophagus narrowing at the LES.
- Manometry: The strength and timing of the esophageal muscle contractions and lower esophageal sphincter (LES) relaxation may be measured using this test. When the LES fails to relax in response to swallowing, and there is no contraction of the muscles along the esophagus walls, the test is said to be positive for achalasia.
- Upper endoscopy: A narrow, flexible tube with a camera on one end known as an endoscope is passed from the mouth down into the esophagus. The camera helps in obtaining images of the inside of the esophagus onto the screen for evaluation. Endoscopy can also be used for the collection of sample tissue (biopsy), which is later sent to the laboratory to check for the presence of any cancer cells. ( Know more about- What is the Purpose of Endoscopy? )
What is the treatment of Achalasia?
The treatment of achalasia focuses on the relaxation or opening of the lower esophageal sphincter allowing the food and liquid to move easily through the digestive tract. The treatment depends on the age of the patient, the overall health of the patient, and the severity of the disease. The different surgical modalities include:
Non-surgical treatment:
- Pneumatic dilation: A balloon is inserted using an endoscope into the center of the esophageal sphincter, and then inflated for enlarging the opening. The procedure may require repetition if the esophageal sphincter does not stay open.
- Botox injections: This is a type of muscle relaxant that can be directly injected into the esophageal sphincter using an endoscopic needle. This form of treatment has effects lasting not more than six months and is recommended only in cases where pneumatic dilation or surgery is not recommended.
- Medications: Certain muscle relaxants like nifedipine and nitroglycerin may be given before eating.
Surgery:
- Heller myotomy:
- The muscle at the lower end of the esophageal sphincter is cut by the surgeon to allow the food to pass easily into the stomach.
- This procedure is mostly done using a tube called a laparoscope with a camera and light on one end, which is inserted through five small keyhole incisions (cuts) made in the abdomen (stomach) by the surgeon. This is known as non-invasive or laparoscopic Heller myotomy.
- A common side effect of the Heller myotomy procedure is the development of gastroesophageal reflux disease or GERD (a condition in which the stomach acid flows back up into the food pipe).
- Therefore, a procedure known as laparoscopic fundoplication is performed at the same time as Heller myotomy.
- In this procedure, the surgeon wraps the top part of the stomach around the lower esophagus (food pipe).
- This creates an anti-reflux valve that prevents the stomach acid from coming back into the esophagus
- Peroral endoscopic myotomy:
- An endoscope tube is inserted through the mouth, down into the throat in order to make an incision inside the lining of the esophagus.
- The surgeon then cuts the muscle present at the lower end of the esophageal sphincter.
- This procedure may also be combined with fundoplication to prevent GERD.
How to care after surgery for Achalasia?
- You will be able to go home in a day or two after the surgery.
- The doctor may prescribe medications to get relief from acid reflux or heartburn, which is a common side effect of surgery, as well as pneumatic dilation.
- It is normal to have some chest pain after the procedure. The doctor will recommend pain medications to relieve the same.
- Drinking cold water also helps in relieving chest pain.
- Stay on a liquid diet for one week after the surgery. You can gradually start with semi-solid food after a week.
- Avoid lifting heavy objects for at least a month after the surgery.
- You can resume work in a few days or a few weeks after the surgery, depending on the severity of the condition and recovery rate.
- Contact your doctor in case of weight loss or swallowing difficulties that persist even after treatment.
- Long term follow-up with your doctor is required to ensure that the esophagus is adequately allowing the food to enter the stomach, check for GERD, and be sure that cancer development has not taken place.
What are the risks of the treatments for Achalasia?
The risks of achalasia treatments could include:
- Formation of a hole in the esophagus
- Gastroesophageal reflux disease ( Know more about- What is Gallbladder Surgery? )
- Bloating
- Recurrence of achalasia
How to prevent Achalasia?
Achalasia cannot be prevented as such. It is a lifelong condition, and treatment helps in relieving the symptoms associated with the condition. Certain lifestyle changes can help in relieving the symptoms associated with achalasia, which include:
- Avoid eating solid foods just before bedtime.
- Sleep with your head in an elevated position.
- Cut the food into small, bite-size pieces.
- Eat-in an upright position.
What is the cost of Achalasia treatment in India?
The total cost of achalasia treatment in India can range from around INR 30,000 to INR 1,30,000. However, many prominent hospital doctors in India specialize in achalasia treatment. But the cost varies across different hospitals and cities.
If you are coming from abroad, apart from the cost of achalasia treatment, there will be an additional cost of living in a hotel and the cost of local travel. After surgery, the patient is kept for 1 day in the hospital and 7 days in the hotel for recovery. So, total cost of achalasia treatment in India comes to be around INR 50,000 to INR 1,60,000.
We hope that we could answer all your questions regarding achalasia through this article.
If you need more information and treatment of achalasia, you can contact a Gastroenterologist.
We only aim to provide you with information through this article. We do not recommend any medication or treatment to anyone. Only a qualified doctor can give you the best advice and correct treatment plan.
