What is Achalasia?

 Achalasia


Achalasia is an esophageal disorder caused due to tightening or contraction of the lower portion of the esophagus (as it loses the ability to relax). The esophageal musculature around the lower esophageal sphincter is affected leading to unopposed contraction. 

The exact cause is not yet known, but its pathogenesis has been linked to loss of neurons (nerve cells) which help dilate the esophagus



Signs and Symptoms 


1. Feeling of food getting ‘stuck’ in the chest.
2. Abrupt onset of difficulty in swallowing both solids and liquids.
3. Heartburn 
4. Vomiting of food undigested food particles 
5. Pain in the chest that is waxing and waning i.e (comes and goes)

Evaluation


 1. Upper Endoscopy to rule out other structural causes of esophageal dysphagia.
 2. Esophageal manometry 

Management 


The type of therapy is decided by considering the severity of signs and symptoms and investigative evaluation. Medical therapy is instituted if the disease is mild and invasive therapy for moderate to severe disease.


Medical therapy


 1. Smooth muscle relaxants like calcium channel blockers like nifedipine, nitrates like nitroglycerin
 2. Oral Sildenafil has also been found to be effective. 
3. Botulinum toxin (Botox) injections at the sphincteric junction



Invasive therapy 


1. Per-oral Endoscopic Myotomy (POEM)
2. Pneumatic dilation 
3. Heller Myotomy

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