Summary about Disease
Oesophageal achalasia is a rare disorder that makes it difficult for food and liquid to pass into the stomach. This occurs because the lower oesophageal sphincter (LES), a muscular ring that closes off the oesophagus from the stomach, fails to relax properly, and the oesophagus loses the ability to squeeze food down into the stomach (peristalsis).
Symptoms
Common symptoms include:
Dysphagia (difficulty swallowing) - for both solids and liquids
Regurgitation of undigested food or liquid
Chest pain or discomfort
Coughing, especially at night
Weight loss
Heartburn (less common, can be due to food sitting in the oesophagus)
Globus sensation (feeling of a lump in the throat)
Pneumonia (due to aspiration of regurgitated material)
Causes
The exact cause of achalasia is not fully understood, but it's believed to be related to:
Loss of nerve cells (neurons) in the oesophagus: This loss of neurons impairs the ability of the oesophagus to contract and the LES to relax.
Autoimmune component: Some research suggests an autoimmune reaction may play a role in damaging the nerve cells.
Genetic predisposition: There may be a genetic component in some cases, but achalasia is usually not inherited.
Infection: In rare cases, it can be caused by parasitic infection, specifically Trypanosoma cruzi (Chagas disease), although this is more prevalent in South America.
Medicine Used
Medications are mainly used to manage symptoms, as they don't cure achalasia. Common medicines include:
Calcium channel blockers (e.g., nifedipine, diltiazem): These can help relax the LES, but are generally not as effective as other treatments and have side effects.
Nitrates (e.g., isosorbide dinitrate): Similar to calcium channel blockers, they relax the LES.
Botulinum toxin (Botox) injection: Injected directly into the LES to paralyze the muscles, helping it relax. This is a temporary solution (typically lasting 6-12 months) and may require repeat injections. Important Note: The above medications are generally used temporarily or in situations where definitive treatment is not immediately possible. More effective long-term treatments involve procedures like pneumatic dilation or surgery (Heller myotomy).
Is Communicable
No, oesophageal achalasia is not a communicable disease. It cannot be spread from person to person.
Precautions
Precautions focus on managing symptoms and preventing complications:
Eat slowly and chew food thoroughly: This aids in easier passage of food.
Drink plenty of fluids with meals: Helps wash down food.
Avoid eating close to bedtime: Reduces the risk of regurgitation while lying down.
Elevate the head of the bed: Further reduces the risk of nighttime regurgitation and aspiration.
Follow medical advice regarding diet and treatment: Adhere to recommended medications or procedures.
How long does an outbreak last?
Achalasia is not an "outbreak"-related disease. It's a chronic condition. Without treatment, the symptoms will persist indefinitely. The duration of symptom relief depends on the type of treatment received. Botox injections provide temporary relief, while pneumatic dilation or surgery can provide longer-lasting relief, although symptom recurrence is possible.
How is it diagnosed?
Diagnosis typically involves:
Manometry: This is the most important test. It measures the pressure and muscle activity in the oesophagus, demonstrating the lack of peristalsis and failure of the LES to relax.
Upper endoscopy (oesophagogastroduodenoscopy or EGD): A thin, flexible tube with a camera is inserted into the oesophagus to visualize the lining and rule out other conditions like tumours.
Barium swallow (oesophagram): The patient drinks a barium solution, and X-rays are taken to visualize the oesophagus. It shows the characteristic "bird's beak" appearance at the LES in achalasia.
High-resolution manometry: newer type of manometry for improved detection.
Timeline of Symptoms
The onset of symptoms can be gradual.
Early stages: Intermittent dysphagia, often for solids only.
Progression: Dysphagia becomes more frequent and affects both solids and liquids. Regurgitation may occur sporadically.
Advanced stages: Dysphagia is severe and constant. Regurgitation is common, leading to weight loss and potential aspiration pneumonia. Chest pain may become more prominent.
Important Considerations
Risk of aspiration: Regurgitation can lead to aspiration of food into the lungs, causing pneumonia or other respiratory problems.
Increased risk of oesophageal cancer: Patients with achalasia have a slightly increased risk of developing squamous cell carcinoma of the oesophagus, particularly many years after the initial diagnosis. Regular surveillance may be recommended.
Treatment is aimed at symptom relief: While there is no cure for achalasia, effective treatments can significantly improve the quality of life.
Long-term follow-up is important: Even after successful treatment, regular monitoring is recommended to assess for symptom recurrence and potential complications.
Different treatment options exist: The best treatment approach depends on the individual patient's symptoms, age, overall health, and preferences.