The name of the disease comes from the Greek word "a-khalasis," which means "failure to relax." Normally during swallowing, the muscles in the esophagus contract in a wave-like manner to propel food downward, and the valve at the lower end (lower esophageal sphincter) relaxes to allow food to pass into the stomach. In achalasia, however, this coordinated movement is disrupted. As a result of the failure of the muscles at the lowest part of the esophagus to relax sufficiently, the passage of food into the stomach becomes difficult. Although it is rare, it is a disease that can lead to serious problems when left untreated.
Causes and Risk Factors of Achalasia
- It can be seen at any age; however, it is most commonly diagnosed between the ages of 25 and 60.
- It occurs with equal frequency in women and men.
- The risk may increase in people with autoimmune diseases.
- It is worth noting that achalasia is not a hereditary disease. The risk may increase slightly in individuals with a family history of achalasia, but a direct inheritance pattern from parent to child has not been defined.
- It is thought that particularly certain viral infections might trigger the disease by affecting nerve tissue.
WhatsApp Info Line What Are the Symptoms of Achalasia?
- Dysphagia (difficulty swallowing): It is seen in more than 90% of patients. A sensation occurs as if the bolus is stuck in the chest area for both solid and liquid foods. It is the most important symptom seen in achalasia.
- Regurgitation: This is the backflow of food or saliva into the mouth that could not pass into the stomach. It becomes particularly pronounced when lying down.
- Chest pain: Retrosternal (behind the breastbone) pain is observed in approximately 40-60% of patients. It can sometimes be confused with cardiac pain or reflux.
- Weight loss: It is seen as a result of malnutrition due to difficulty swallowing and a preference not to eat.
- Nocturnal cough and aspiration: Food accumulating in the esophagus can escape into the lungs when lying down at night.
Attention: Coughing fits when lying down at night may suggest achalasia. If difficulty swallowing both solid and liquid foods lasts for more than 2 weeks, consult a gastroenterology specialist.
Types of Achalasia (Chicago Classification) and the Diagnosis Process
Achalasia disease is not of a single type; it has different subtypes. This distinction is made by a special measurement method called "high-resolution manometry (HRM)." In this method, the muscle movements of the esophagus are examined in detail. This system, referred to as the Chicago Classification (v4.0), divides achalasia into three different types. HRM both establishes the diagnosis and determines the type of the disease.
Diagnosis of Achalasia;
- Barium Swallow Test (Esophagogram): The patient drinks a barium liquid and an X-ray is taken. In achalasia, narrowing at the lower part and dilation at the upper part can be observed.
- Upper Gastrointestinal Endoscopy (Gastroscopy): The esophagus and stomach are directly examined with an endoscope. It is performed to rule out other diseases that might cause complaints similar to achalasia. The endoscope passes into the stomach with difficulty.
- Timed Barium Swallow Test (TBE): The transit time of the swallowed substance through the esophagus is measured. It is also used in the follow-up of improvement after treatment.
Achalasia Treatment Methods
The choice of treatment in achalasia must absolutely be individualized. The same method is not suitable for every patient. Regular follow-up is required after treatment.
- Pneumatic dilation (Balloon dilation)
- Laparoscopic Heller Myotomy (LHM)
- Peroral Endoscopic Myotomy (POEM)
- Botulinum toxin (Botox) injection
- Medication therapy: It is generally not the first choice and does not provide a permanent solution. However, it can be used in patients who are not suitable for surgery or interventional treatment, or for the purpose of providing temporary relief.
Frequently Asked Questions
Is Achalasia a Dangerous Disease?
It is not a directly life-threatening disease. However, if left untreated, difficulty swallowing increases, and weight loss and nutritional problems can develop. In the long term, dilation in the esophagus and, rarely, an increase in cancer risk can be observed.
Does Achalasia Recover Completely?
It does not disappear completely. However, with the applied treatments, complaints can be controlled to a great extent and patients can continue their normal lives.
What Is the Difference Between Achalasia and Reflux?
These two diseases are frequently confused, but the mechanism is completely different. In achalasia, the valve at the bottom of the esophagus does not open sufficiently, which is why swallowed food has difficulty passing into the stomach and the person experiences difficulty swallowing. In reflux, the exact opposite situation exists; this valve remains loose, and stomach acid escapes upward into the esophagus. In short, achalasia is a problem of "failure to pass," while reflux is a problem of "backflow."
Is the Manometry Test Painful?
It is generally not a painful procedure, but a brief sensation of discomfort can occur because a thin tube is passed through the nose. The procedure usually takes a few minutes and can be tolerated by most patients.
