Achalasia – causes, symptoms & therapy

Achalasia is an esophageal dysfunction that affects the muscles . In a healthy person, the muscle relaxes during swallowing to allow food to enter the digestive tract. Achalasia sufferers, on the other hand, also have a tense muscle during swallowing.

In addition, decreased activity of the middle and lower sections of the esophagus can usually be seen. These in turn are responsible for transporting the food. The esophagus itself is a muscular tube. The esophagus is closed by a muscle to ensure that the leftovers are discharged in a controlled manner and that no stomach acid penetrates into the esophagus. If this function is disturbed, it is referred to as achalasia.

causes

Achalasia is divided into a primary and a secondary manifestation. The primary disease is idiopathic. The exact reason for its origin is not known. Ultimately, the nerve cells in the lower region of the esophagus are destroyed. Such a process is called neurodegeneration. The musculature shows a loss of nerves in the further course.Complaints result from the lack of supply: the sphincter muscle remains tense, while the muscle movements generally decrease in activity. However, it is not yet known why neurodegeneration occurs at all. Experts suspect that the symptoms occur as part of an autoimmune disease that is inherited.

Furthermore, in some cases, achalasia is accompanied by other complaints. These include Down syndrome , Sjörgen syndrome and AAA syndrome. Secondary achalasia often results from a narrowing of the section that connects the esophagus and stomach . In many patients, the narrowing is caused by a tumor .

When to the doctor?

Persistent problems with swallowing should be checked by a doctor. If food cannot be transported into the esophagus as usual despite being sufficiently chopped up in the mouth, a doctor should be consulted. Unusual changes in the tension of the muscles in the esophagus should be examined and clarified by a doctor. If there are problems with the intake of liquids or if the feeling of the saliva being transported away in the throat changes, the symptoms should be examined by a doctor.

If other symptoms occur, a doctor’s visit is necessary. They include chest pain, persistent muscle discomfort in the throat, or difficulty swallowing . If the person concerned also has to burp continuously, it is also advisable to consult a doctor.

If weight changes occur due to the symptoms or if circulatory problems or dizziness occur, a doctor’s visit is necessary. In these cases, achalasia has lasted for a long time and triggers other diseases that severely impair the state of health. If the person concerned chokes unusually often, there is a risk that parts of the ingested food will enter the windpipe. A doctor should be consulted as substances left in the trachea can cause inflammation. In addition, there is a risk of permanent damage to the lungs if swallowed.

symptoms and course

Typical pain against achalasia:

• dysphagia

• chest pain

• burping

• pain when swallowing

The symptoms of achalasia are particularly noticeable during and after eating. At first they are usually perceived as mild. The symptoms only get worse over time, and they occur more and more frequently. In general, those affected suffer from swallowing disorders, chest pains and regurgitation of leftover food that has not yet been digested.

The swallowing disorders develop primarily when consuming solid food. Patients often feel that the food is getting stuck in the tube, so they try to force the food into the stomach with water. If the disease progresses, it is often not possible to eat soft or liquid food without symptoms.

In particular, when patients lie down, food particles penetrate back into the oral cavity. In some cases, such a process leads to pneumonia if the remnants enter the respiratory tract. Because achalasia is a handicap, many patients lose weight as a result of the disease. Sometimes there is also pain when swallowing. These usually occur when stuck food ignites and attacks nearby structures.

diagnosis

Diagnosis often takes a long time. Because achalasia only has a few symptoms at the beginning, it is often only recognized in advanced stages. After an initial suspicion by the doctor, this must be proven with the help of various examinations. For example, an endoscopy is performed. Inflammation or stuck food residues can already be detected during mirroring. X-ray images provide further information . Manometry allows the pressure to be measured. In this way, the functionality of the sphincter muscle can be understood.

complications

Unfortunately, with regard to achalasia, a variety of complications can occur that have not yet been fully clarified and recorded at the present time. In the main, aspiration pneumonia (inflammation of the lungs) can occur as a result of so-called regurgitations – which means that food components are pushed back. There is a risk of food residue penetrating the respiratory tract and consequent sticking. In addition, the esophagus can become inflamed if food remains in the esophagus for too long, resulting in retention esophagitis. This in turn can shorten the esophagus and is also considered a precursor to esophageal carcinoma.

As a further complication / as a further risk, however, it can also be seen that the symptoms of achalasia are misinterpreted in the early stages. Heart disease is often assumed and the patient is referred to a cardiologist, who, despite several complex tests, certifies a completely healthy heart. As a result, important treatment time is wasted, which in turn can lead to the actual complications mentioned above. In addition, the causes of the disease and the possible complications that may arise have not yet been fully medically clarified, which also extends the treatment time.

treatment and therapy

The treatment of achalasia should start at the latest when the disorder affects the swallowing process. The treatment focuses on alleviating the existing symptoms. The aim of the various measures is to reduce the pressure in the esophagus. In this way, the chyme can easily pass through the stomach. However, in the primary form, it is not possible to correct the underlying cause of achalasia.

Dead nerve tissue cannot be treated in such a way that the cells regenerate and are functional again. Instead, there are drugs that are able to effectively lower the pressure.

Active ingredients that are normally used to treat high blood pressure and coronary heart disease are often used for this: calcium antagonists and nitrates. For an optimal effect, the tablets are taken about 30 minutes before the meal. In the long run, however, regular intake of the medication often leads to a reduction in the effect. As soon as the tablets lose their effectiveness, other measures must be taken.For example, manual widening of the constricted area helps. One of the methods is balloon dilation. Here a hose is led to the constriction during a reflection. There is a small balloon at the bottom of the tube, which is then inflated.

prevention

Achalasia cannot be prevented because the exact cause is largely unknown. Anyone suffering from the disease should have their esophagus checked regularly after successful treatment. Furthermore, avoiding alcohol and nicotine can at least minimize the risk of accompanying diseases.