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Achalasia

Below:
• What is achalasia?
• What causes achalasia?
• What are the symptoms?
• How is achalasia diagnosed?
• How is it treated?
• Are there any complications?

What is achalasia?

Achalasia is a motility disorder of the oesophagus (the tube that carries food from the mouth to the stomach). In achalasia, the muscle of the lower oesophagus and the lower oesophageal sphincter (the ring of muscle at the junction of the oesophagus with the stomach) fail to relax and let food pass into the stomach. This causes difficulty swallowing food.
Achalasia is quite rare and typically occurs in adults aged 25-60 years.

What causes achalasia?

Normally, after swallowing, a wave of muscular contraction (peristaltic wave) passes along the oesophagus. By the time the peristaltic wave reaches the lower sphincter, the sphincter is open and the food passes into the stomach. In achalasia, there is an absence of normal peristalsis in the lower oesophagus and the lower oesophageal sphincter fails to relax. These abnormalities cause food to stick in the oesophagus.

The actual cause of achalasia is unknown. One theory is that achalasia is an auto-immune disorder.

Early in achalasia, microscopic inflammation can be seen in the muscle of the lower oesophagus, especially around the nerves. As the disease progresses, the nerves begin to degenerate and ultimately disappear, particularly the nerves that cause the lower oesophageal sphincter to relax. Muscle cells then begin to degenerate, possibly because of the damage to the nerves. As a result the lower sphincter cannot relax and muscle in the lower oesophageal body cannot support peristaltic waves. With time, the body of the oesophagus stretches and becomes very dilated.