Achalasia is a condition in which the muscles of the esophagus fail to relax during swallowing. As a result, food that is swallowed may remain in the esophagus for long periods of time.
This condition can produce a number of symptoms:
- The feeling of food sticking or filling up under the breast bone
- Chest pain that may feel like a heart attack
- Nausea and vomiting of undigested food
- Weight loss
A variety of high-tech procedures and advanced imaging techniques can be used to accurately diagnose achalasia and help determine the most effective treatment. These include:
- Barium swallow. In achalasia, the esophagus does not contract when swallowing, and the muscle between the esophagus and stomach does not relax. Swallowed barium solution can indicate achalasia if it lingers in the esophagus for a long time.
- Esophageal manometry. Esophageal manometry evaluates how the esophagus functions. In achalasia, it can detect a lack of contraction of the esophagus when swallowing and that the muscle between the stomach and esophagus does not relax.
- Upper GI endoscopy. On some occasions abnormal growths or scars in the esophagus can be confused with achalasia. Upper GI endoscopy is done to make sure that there is no abnormal growth or scar of the esophagus before making a diagnosis of achalasia.
All of the treatments currently used to treat achalasia relax the contraction of the sphincter between the stomach and esophagus. This allows food to pass more easily into the stomach. Available treatments include:
- Botulinum toxin (BoTox®) injection
- Drugs (i.e., nitrates or calcium channel blockers). While they do help some patients, overall they are not very effective.
- Achalasia balloon dilation
- Heller's myotomy is a surgery to cut the muscle between the stomach and esophagus