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Alternative names Return to top
Esophageal achalasiaDefinition Return to top
Achalasia is a disorder of the esophagus (the tube that carries food from the mouth to the stomach). The esophagus is less able to move food toward the stomach, and the valve from the esophagus 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.Causes, incidence, and risk factors Return to top
The main abnormality in achalasia is a failure of the lower esophageal sphincter (a muscular ring at the junction of the esophagus and stomach) to relax during swallowing. The disorder is characterized by loss of the wave-like contraction of smooth muscles that forces food through the digestive tract. (These contractions are called peristalsis.)
Another part of the disorder is lack of nervous stimulation to the esophagus. Causes include damage to the nerves to the esophagus, parasitic infection, cancers, and hereditary factors. Achalasia is a rare disorder, may occur at any age, but is most common in middle-aged or older adults.
Symptoms Return to top
Signs and tests Return to top
An upper GI x-ray test or barium esophagogram may show absence of peristalsis, a dilated proximal esophagus, and a narrowing at the bottom of the esophagus. The diagnosis is confirmed with esophageal manometry. Physical examination may show signs of anemia.
Treatment Return to top
The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter with special instruments.
Therapy usually involves dilation of the lower sphincter or injection with botulinum toxin to paralyze it and prevent spasms. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter.
Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.
Expectations (prognosis) Return to top
Surgical outcomes are good -- dilation alone often results in only temporary improvement in symptoms.
Complications Return to top
Calling your health care provider Return to top
Call your provider if you have persistent difficulty swallowing or painful swallowing, or if symptoms persist despite treatment for achalasia.Prevention Return to top
Many of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.
Update Date: 5/14/2004 Updated by: Christian Stone, M.D., Division of Gastroenterology, Washington University in St. Louis School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |