Achalasia is defined by the enlargement of the esophagus, restricted ability to propel food down toward the bowels (peristalsis), and failure of the ring-shaped muscular tissue at the end of the esophagus, the lower esophageal sphincter muscle (LES), to widen. It is the muscular contraction and relaxation of the sphincter muscle that propels food particles through the pipe.
Symptoms and Signs of Achalasia
The major symptoms of achalasia are dysphagia (trouble with swallowing) and regurgitation of meals. Dysphagia seems to get worse over time and tends to include both solids and fluids. Some achalasia victims also go through weight loss, coughing when resting, chest burning which may be perceived as heartburn or pyrosis.
Liquids and foods, including saliva, are held in the esophagus and can be inhaled into the respiratory organs (aspiration), potentially leading to aspiration pneumonia.
Diagnosis of Achalasia
Because of the similarity of signs and symptoms, achalasia can be misidentified for more general disorders such as gastro-esophageal reflux disease (GERD), hiatal hernia, and even "psychosomatic" illnesses, in which symptoms are induced by mental processes of the individual rather than physiological causes. A “bird's beak" appearance of the esophagus, as occasionally described by the medical community, is very typical for achalasia.
Some examples of tests for achalasia include: barium swallow and esophageal manometry; endoscopy of the esophagus, the GI tract and duodenum (esophago-gastro-duodenoscopy or EGD), with or without endoscopic sonography, is generally performed to eliminate the possibility of cancer. The internal structure of the esophagus usually appears normal in endoscopy, although a "pop" may be detected as the scope is advanced through the un-relaxed lower esophageal sphincter muscle, and food debris may be detected above the LES.
Medical Procedures Related to Achalasia
The individual swallows a barium solvent, with continuous fluoroscopy (X-ray readings) to investigate the flow of the liquid through the esophagus. Conventional peristaltic movement of the esophagus isn't observed. There is acute irritation at the lower esophageal sphincter muscle and narrowing at the gastro-esophageal junction, creating a "rat's tail" or "bird's beak" appearance.
The part of the esophagus above the narrowing is often expanded (dilated) to varying degrees as the esophagus is slowly stretched over time. An air-fluid border is sometimes observed over the barium hose due to the absense of peristalsis. A five-minute barium swallow is a useful resource for evaluating the quality of treatment.
Due to of its sensitivity, manometry (an test for the esophagus) is often perceived as the key exam for making the diagnosis. A thin pipe is pushed through the nose, and the affected individual is told to swallow a few times. The probe measures muscular contractions in different sections of the esophagus during the process of swallowing.
Manometry uncovers any failure of the lower esophageal sphincter to relax after swallowing and non-functional peristalsis (movement of food) in esophagus.
Biopsy, the removal of tissue sample, during an endoscopy is usually not necessary in achalasia, but if performed, it shows hypertrophied musculature (enlarged muscles) and absence of certain nerve cells of the myenteric plexus, a network of nerve fibers that controls the movement of food throught the esophagus.
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References:
"Achalasia." New England Journal of Medicine. Volume 360:801 February 19, 2009 Number 8.
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