Definition:

Achalasia is a disorder that prevents the movement of food through the esophagus, the tube that connects the mouth to the stomach.  At the junction of the esophagus and stomach, there is a valve which regulates how much food enters the stomach.  In achalasia, the valve does not relax as much as it is supposed to and this causes improper food entry into the stomach. This is caused by the loss of peristalsis, the wave-like contractions that move the food in a synchronous manner down to the stomach.  Also, loss of nervous innervation to the esophagus can lead to achalasia, and causes of loss of innervation include cancer, infection, and hereditary factors.

Symptoms:

• Difficulty swallowing
• Food regurgitation
• After eating, chest pain that extends to back, neck, arms
• Weight loss
• Heartburn
• Cough

Diagnosis:

• Physical examination - may show signs of anemia
• Upper GI & Small Bowel series - no peristalsis recorded
• Esophageal manometry - confirmation of no peristalsis via pressure tests
• X-Ray - using barium contrast to see lower esophagus narrowing
• Endoscopy - directly looking at inner walls of esophagus to see narrowing

Treatment:

• Surgery - manipulation of the valve at the stomach-esophageal junction (lower esophageal sphincter) to reduce pressure
• Balloon dilation of the lower esophagus
• Injection of botulinum toxin to prevent spasms of esophagus
• Calcium channel blockers/long-acting nitrates - reduce pressure in esophagus
• Heller Myotomy - if all else fails; decreases pressure at lower esophageal sphincter

Complications:

• Tearing of esophagus
• Food leaving esophagus and entering lung (causes pneumonia)
• Esophageal cancer