Achalasia is classified as a rare disease that can be inherited. Achalasia itself refers to a condition where the esophagus loses its ability to push food from the mouth to the stomach.Under normal conditions, the Lower Esophageal Sphincter (LES) will relax, so that food can enter the stomach. The LES is a ring of muscle located at the bottom of the esophagus. The LES opens and closes on its own to prevent stomach acid from rising into the esophagus.
Well, in people with achalasia, the LES cannot relax properly, so that food accumulates at the bottom of the esophagus or rises back up into the mouth.
Causes of Achalasia
The exact cause of achalasia is not fully understood. However, researchers suspect that there are several conditions that can trigger achalasia, such as:
- Damage to the nerves in the esophagus which then causes the muscles and muscle rings in the throat to not function optimally.
- The presence of a viral infection.
- Complications due to Chagas (infection with the parasite Trypanosoma cruzi ).
- Cancers such as stomach cancer and lymph node cancer.
- An autoimmune condition in which the body’s immune system attacks healthy cells, tissues, and organs.
- Genetic or hereditary factors in the family.
Types of Achalasia
There are a variety of muscle disorders in the esophagus that people with achalasia experience. In most cases, the lower esophageal sphincter that controls the passage between the esophagus and the stomach is unable to relax at the right time.
Based on other problems that occur together, doctors identify three types of achalasia, namely:
1. Achalasia type 1 (classic achalasia)
In this type, the esophageal muscles barely contract, so food moves down only due to gravity.
2. Achalasia type 2
Pressure builds up in the esophagus, causing it to become compressed. This is arguably the most common type of achalasia and often causes more severe symptoms than type 1.
3. Achalasia type 3 (spastic achalasia).
This type of achalasia has abnormal contractions at the bottom of the esophagus, where it meets the stomach .
This is the most severe type of achalasia, as the contractions can cause chest pain that wakes a person from sleep and the symptoms are similar to a heart attack.
Achalasia Risk Factors
The main cause of achalasia is damage to the nerves in the esophagus, so that the muscles cannot work properly.
Apart from nerve damage, achalasia can also occur due to the following risk factors:
- Suffered a spinal injury.
- Undergoing endoscopic sclerotherapy.
- Having a viral infection.
- Have an autoimmune disease.
- Having a history of achalasia in the family.
- Weak immune system in the nerve cells of the esophagus.
- Aged 40-60 years.
- Suffering from Down syndrome .
Find out more, here are some risk factors for people who can get Achalasia .
Achalasia Symptoms
Not all sufferers experience symptoms of achalasia. Most of them only have difficulty swallowing food or drink.
The following are symptoms of achalasia that often appear, such as:
- Throat feels sore when swallowing food or drink.
- Food comes back into the mouth, like I want to vomit.
- Coughing when swallowing due to choking.
- Increased production of stomach acid .
- Pain in the chest area.
- Having recurrent chest infections.
- Vomiting saliva due to increased production of stomach acid.
- Weight loss is slow, but it is significant.
As explained above, achalasia often makes sufferers have difficulty swallowing food and drinks. As a result, the throat feels sore or uncomfortable.
Well, if you experience this, you can try to overcome it with these 5 recommendations for effective medicines for painful swallowing at the pharmacy .
These symptoms can be experienced by anyone, and can occur at any time. If these symptoms are left untreated, the risk of esophageal cancer increases.
Therefore, immediately take the right treatment steps when you find the symptoms.
Achalasia Diagnosis
The diagnosis process is carried out by a specialist doctor based on the results of the interview and complaints experienced by the sufferer. Then, the doctor continues the diagnosis process by conducting a physical examination and other supporting tests.
Here are some supporting examinations that you need to do:
- Manometry, which involves inserting a small plastic tube through the mouth or nose into the esophagus to measure muscle pressure along the airway.
- Esophagography, which is done by drinking a white liquid containing barium. The liquid will be clearly visible on X-ray. Its purpose is to see how long it takes for food and drink to enter the stomach.
- Endoscopy, which is performed using fiber optics and a camera to directly view the lining of the esophagus, muscle rings and organs in the sufferer’s stomach.
Achalasia Treatment
Treatment for achalasia aims to open the LES muscle, so that food and drink can enter the stomach.
Here are some common treatment procedures:
1. Medicines
Taking medication from a doctor can help relax the muscles in the esophagus, making the swallowing process easier and less painful.
This procedure does not necessarily work for everyone, and the effects are temporary. The use of medication usually serves to relieve symptoms, while waiting for other treatments.
2. Muscle stretching
Before the procedure, the achalasia sufferer is first given general anesthesia. Then, the doctor inserts a balloon-like object, which will be pumped up to help stretch the throat muscle ring.
The goal is to increase muscle elasticity when swallowing. This procedure carries a small risk of tearing the esophagus, requiring emergency surgery.
3. Botox injection
Botox fluid is inserted into the esophagus using an endoscope, and injected into the muscle ring. The goal is to relax the throat muscles, so that swallowing is not painful.
Although effective, the procedure must be repeated over several months to years. This method is an alternative for people who cannot undergo other treatments.
4. Operation
The surgical procedure is performed by cutting the ring muscle, allowing food to enter the stomach.
The results can be felt permanently and make it easier for sufferers to swallow without pain.
When these methods do not work, some people may need surgery to remove part of their esophagus.
5. Peroral Endoscopic Myotomy (POEM)
POEM is a procedure performed using a tool called an endoscope. The tool is equipped with a camera and flashlight on the end to obtain images of the esophagus, stomach, small intestine, and large intestine.
This procedure aims to reduce muscle stiffness, so that food and drink can easily flow into the stomach.
In general, peroral endoscopic myotomy is performed with the following steps:
- The ENT specialist will insert an endoscope tube through the mouth to the esophagus. The doctor controls the direction of this tool by looking at images taken by the camera at the end of the endoscope.
- In addition to the light and small camera, the endoscope also has a special small knife on the end. While the tool is in the esophagus, the small knife will cut and relax the stiff esophageal muscles that trigger swallowing problems.
- The small knife can also cut and relax the muscles on the sides of the esophagus, the lower esophageal valve, and the upper part of the stomach.
- Once completed, a clamp will be inserted into the wall of the esophagus to keep the incision closed.
- Next, the endoscope tube will be removed through the patient’s mouth.
6. Pneumatic dilation
This treatment is performed using a balloon-like device, which is inserted endoscopically into the middle of the esophageal sphincter and inflated to enlarge the opening. This outpatient procedure may need to be repeated if the esophageal sphincter does not stay open.
Nearly one-third of people treated this way require repeat treatment. At least within five years. In addition, the procedure requires sedation.
As with other treatment procedures, a number of steps to overcome achalasia can also trigger complications. Some conditions that become complications of achalasia treatment, such as holes in the esophagus, bloating, chronic digestive disorders, and the return of achalasia symptoms.
Are you experiencing this health problem? Here’s How to Treat Achalasia or Difficulty Swallowing!
Achalasia Complications
Generally, complications of achalasia arise due to a number of symptoms experienced not being treated with appropriate treatment steps.
Complications occur gradually, ranging from increasing difficulty swallowing food and drink, to weight loss due to malnutrition .
Here are other complications:
- Esophageal or throat cancer.
- Stomach acid rises into the esophagus.
- Pneumonia which causes food to enter the lungs.
- Esophageal perforation is a tear in the wall of the esophagus.
Achalasia Prevention
If caused by genetic factors, there are no preventive measures that can be taken. However, you can do an early examination, so that a number of symptoms that appear can be treated with the right steps.
Here are some steps to prevent achalasia:
- Quit smoking.
- Increase your consumption of water while eating.
- Chew food until completely smooth before swallowing.
- Do not consume foods that can trigger increased stomach acid, such as spicy, sour foods, and foods and drinks that contain caffeine.
- Eat small portions but often.
- Do not consume food close to bedtime.
- Position your head higher when sleeping.
Everyone certainly does not want to experience it. For that, see Here are 5 Simple Ways to Prevent Achalasia.
When to See a Doctor?
If a number of the symptoms mentioned above appear and get worse over time, you should consult a doctor at Halodoc.
Find out more, here are 5 Achalasia Symptoms that Make it Difficult to Swallow .
In addition, if you have risk factors for achalasia or have family members with a history of similar disease, immediately have an early examination by a doctor .
Your doctor may refer you to a specialist. This is important to do so that you can avoid the risk of achalasia and its complications.
