Esophageal Diseases

ACHALASIA = A Swallowing Disorder

Achalasia is a swallowing disorder that occurs when the muscle tissue that controls the passage of food in the area connecting the esophagus to the stomach (the lower esophageal sphincter, LES) fails to relax because the nerve cells in this tissue are damaged for unknown reasons.

WHO IS AT RISK OF ACHALASIA?

• Genetic predisposition,
• Immune system disorders,
• Viral infections.

WHAT ARE THE SYMPTOMS OF ACHALASIA?

Although their frequency and severity vary from person to person, the most common complaints are:

• Difficulty swallowing,
• Coughing and a choking sensation at night due to regurgitation,
• A burning feeling in the chest,
• Solid or liquid food coming back up into the mouth (regurgitation),
• Pressure and pain in the chest,
• Belching,
• Hiccups,
• Weight loss

HOW IS ACHALASIA DIAGNOSED?

After an examination by a specialist:

• Endoscopy,
• Esophagogram
• Manometry: a method of measuring the pressure at the junction of the esophagus and stomach using a tube passed through the nose.

WHAT ARE THE TREATMENT OPTIONS FOR ACHALASIA?

Although there is no method that provides a complete cure, treatment approaches that improve quality of life by reducing complaints and symptoms include:

• Pneumatic dilation: Under anesthesia and with the help of endoscopy, a balloon is inflated to widen the affected area. It may need to be done more than once.
• Botox: Injected into the affected muscle tissue with the help of endoscopy to relax it. Because its benefit may last 3–12 months, the procedure can be repeated.
• Surgery: Myotomy performed laparoscopically. A fundoplication to prevent reflux can be performed in the same session.
• Peroral Endoscopic Myotomy (POEM): It can be performed in some people. However, because reflux becomes more common after the procedure, it is preferred only for certain patients.

COMPLICATIONS OF ACHALASIA

• Aspiration pneumonia: Pneumonia caused by solid and liquid food that has come back up into the mouth entering the respiratory system.
• Esophageal perforation: A life-threatening condition.
• Esophageal cancer: The risk is higher in patients with achalasia. Close follow-up may be needed.

LEARNING TO LIVE WITH ACHALASIA

Achalasia is a chronic disease. If you have swallowing difficulty and regurgitation (food coming back up into the mouth):

• Do not smoke under any circumstances.
• Avoid foods and drinks that cause heartburn.
• Chew your food very well and drink plenty of water with meals.
• Eat in small bites.
• Do not eat late at night.
• If your complaints get worse at night, raise your head.

At our hospital, patients with achalasia are evaluated with a multidisciplinary approach to reduce their complaints and improve their quality of life.