Esophageal Achalasia Symptoms and Causes

Symptoms

• Difficulty swallowing (dysphagia) solids and liquids
• Regurgitation of food
• Chest pain or discomfort
• Coughing or choking on food
• Weight loss
• Heartburn
• Difficulty burping or vomiting

Causes

• Unknown in most cases, but believed to be related to:
  • Damage to the nerves that control the esophagus
  • Abnormality in the nerve cells that control the lower esophageal sphincter (LES)
  • Inflammation or scarring of the esophagus
  • Certain genetic disorders or autoimmune diseases
  • Infection with certain viruses or bacteria

Treatment Options

• Medical Therapy:
  • Nitrates or calcium channel blockers to relax the LES
  • Botox injections to temporarily relax the LES
• Endoscopic Therapy:
  • Pneumatic dilation to stretch the LES
  • Botulinum toxin injection to relax the LES
• Surgical Therapy:
  • Laparoscopic Heller myotomy to cut the muscle of the LES
  • Peroral endoscopic myotomy (POEM) to cut the muscle of the LES through the mouth
• Lifestyle Changes:
  • Eating smaller, more frequent meals
  • Avoiding heavy or rich foods
  • Raising the head of the bed 6-8 inches

Diagnosis

• Endoscopy: to visualize the esophagus and rule out other conditions
• Esophagogram: to examine the swallowing process using X-ray
• Manometry: to measure the muscle contractions of the esophagus
• Timed barium esophagogram: to assess the movement of food through the esophagus

Esophageal Motility

• Primary peristalsis: the normal wave-like muscle contraction of the esophagus
• Secondary peristalsis: the contraction of the esophagus in response to food or liquid
• Achalasia: characterized by:
  • Absent or incomplete primary peristalsis
  • Incomplete relaxation of the LES
  • Elevated LES pressure
  • Abnormal esophageal contractions

Symptoms

• Difficulty swallowing solids and liquids due to achalasia
• Regurgitation of food, a common symptom of achalasia
• Chest pain or discomfort associated with swallowing
• Coughing or choking on food, a risk of achalasia
• Weight loss due to difficulty swallowing and eating
• Heartburn, a symptom of achalasia
• Difficulty burping or vomiting, a characteristic of achalasia

Causes

• Unknown causes in most cases
• Damage to nerves controlling the esophagus, a possible cause
• Abnormality in nerve cells controlling the lower esophageal sphincter (LES)
• Inflammation or scarring of the esophagus, a possible cause
• Genetic disorders or autoimmune diseases, a possible cause
• Infection with certain viruses or bacteria, a possible cause

Treatment Options

Medical Therapy

• Nitrates or calcium channel blockers to relax the LES
• Botox injections to temporarily relax the LES

Endoscopic Therapy

• Pneumatic dilation to stretch the LES
• Botulinum toxin injection to relax the LES

Surgical Therapy

• Laparoscopic Heller myotomy to cut the muscle of the LES
• Peroral endoscopic myotomy (POEM) to cut the muscle of the LES through the mouth

Lifestyle Changes

• Eating smaller, more frequent meals to manage symptoms
• Avoiding heavy or rich foods to manage symptoms
• Raising the head of the bed 6-8 inches to reduce symptoms

Diagnosis

• Endoscopy to visualize the esophagus and rule out other conditions
• Esophagogram to examine the swallowing process using X-ray
• Manometry to measure the muscle contractions of the esophagus
• Timed barium esophagogram to assess the movement of food through the esophagus

Esophageal Motility

Normal Motility

• Primary peristalsis: the normal wave-like muscle contraction of the esophagus
• Secondary peristalsis: the contraction of the esophagus in response to food or liquid

Achalasia

• Characterized by absent or incomplete primary peristalsis
• Incomplete relaxation of the LES
• Elevated LES pressure
• Abnormal esophageal contractions

This quiz covers the symptoms and causes of esophageal achalasia, a disorder that affects the esophagus and can cause difficulty swallowing, chest pain, and other symptoms.