Is There A Cure For Achalasia Of The Esophagus?

What can you tell me about a cure for achalasia of the esophagus?

Achalasia is a condition in which the normal muscular contractions and relaxations of the esophagus are distorted and ineffectual, preventing food from passing normally from the esophagus into the stomach. The esophagus is the long muscular tube which conducts food and liquids from our throat through the chest into the stomach. The muscle in it is smooth muscle, which is different from the muscle in our arms and legs which we control voluntarily. Smooth muscle is under involuntary control, and all the muscle of the esophagus, stomach and intestines is of this type.

Smooth muscle does, however, require nerves to activate it and to provide the controlled contraction, called peristalsis, which propels food and liquids along for digestion.

The basic defect in achalasia appears to be a lack of the nerves to provide this controlled peristalsis. The contractions in the esophagus may be weak or disorganized, and the nervous impulses that are necessary to cause the muscle at the bottom of the esophagus to relax, permitting the food to pass easily into the stomach, are inadequate. This muscle, called the lower esophageal sphincter, is normally tight, keeping the acid contents of the stomach from getting back into the esophagus. Failure of this sphincter to remain tight when we are not swallowing is the cause of heartburn, or GERD, but that’s another story.

In a normal person, nice, strong, smooth peristalsis pushes a mouthful of food down the esophagus, and when it reaches the lower esophageal sphincter, the sphincter relaxes and the mouthful passes into the stomach. In achalasia, the peristalsis is often weak and not smooth, and the sphincter does not relax, trapping the food above the stomach. This may cause chest pain, pain on swallowing, and regurgitation of undigested food. In very severe cases, food can build up and cause the esophagus to swell and enlarge. People with a severe case may have trouble even swallowing their saliva, and may aspirate it into their lungs.

The condition can occur at all ages, and equally in men and women. Once started, it tends to progress and become worse. Stress and eating in a hurry will increase the symptoms. In less advanced cases, sleeping upright in a chair, and bearing down with the throat closed to increase the pressure in the chest may help push the food down.

The diagnosis can occasionally be made by a simple chest x-ray which shows a dilated, food-filled esophagus, but the best test involves passing a tube into the esophagus and measuring the pressure while the person is swallowing.

Medical treatments such as eating very soft foods, taking nitrates (the same ones used for angina of the heart), and/or calcium channel blockers may help to relax the sphincter. Ultimately, though, most people with the condition eventually have to have the sphincter dilated by passing a tube with a balloon on it down into the sphincter and blowing up the balloon, which stretches and relaxes the sphincter. There are also surgical procedures to cut the sphincter, but I would personally always try the balloon dilatation first.

The information provided on Health Search Online is for educational purposes only and is not a substitute for medical advice, diagnosis or treatment.