Esophageal Achalasia

Achalasia is an abnormal condition characterized by inability of a muscle to relax, particularly the lower esophageal sphincter (LES) and lack of a coordinated LES relaxation in response to swallowing. The exact origin of achalasia is not known. The most widely accepted current theories implicate autoimmune disorders, infectious diseases, or both. Achalasia is a relatively uncommon disease. Failure of the LES to relax leads to the retention of foodstuffs and upper gastrointestinal secretions in the esophagus. Patients with achalasia report night coughing episodes. Nocturnal coughing can lead to aspiration pneumonia, which is a serious complication. Patients with achalasia are at increased risk for esophageal carcinoma, compared with the general population. Difficulty swallowing (dysphagia) is the most common presenting symptom in patients with achalasia.¹

Signs of Esophageal Achalasia

Animals with achalasia may regurgitate the undigested food from the esophagus during the course of the disease. As the disease progresses, the likelihood that aspiration will occur increases. As a result, some patients may present with signs or symptoms of pneumonia or pneumonitis. Lung abscesses, bronchiectasis, and hemoptysis are some of the more severe pulmonary consequences of achalasia-associated aspiration. Patients with achalasia are at increased risk for esophageal cancer. When esophageal cancer occurs, it is usually found in patients with a long history of achalasia.¹

Achalasia typically occurs in adults aged 25-60 years. Fewer than 5% of cases occur in children. Achalasia is characterized by the following symptoms and signs:

• Difficulty swallowing (dysphagia). This is the most common sign of the disease.
• Regurgitation
• Chest pain
• Heartburn
• Weight loss

Management of Esophageal Achalasia

The goal of therapy for achalasia is to relieve symptoms by eliminating the outflow resistance caused by the hypertensive and nonrelaxing LES. Once the obstruction is relieved, the food bolus can travel through the aperistaltic body of the esophagus by gravity. Surgical treatment is also available.²

References:
1. Michael AJ Sawyer, MD. "Achalasia", eMedicine, June 22, 2006.
2. P Marco Fisichella, MD. "Achalasia", eMedicine, Oct 10, 2006.