Achalasia

The condition causes problems with swallowing

Achalasia is a rare motility disorder of the oesophagus, commonly known as the gullet.

It is known to affect approximately 6,500 people in the UK.

The disease is characterised by a lack of smooth muscle contraction, known as peristalsis, which allows for food to pass along the gullet into the rest of the digestive tract.

In addition, there is an associated failure of relaxation of the ring of muscle at the lower portion of the oesophagus - the lower oesophageal sphincter.

What are the symptoms?

The main symptoms of such a disorder are swallowing difficulties, in particular painful swallowing or dysphagia, for both liquid and solid foods.

In certain cases individuals may experience regurgitation of food or chest pain primarily behind the breast bone.

What is the cause?

The cause of the disease is still unknown.

It is associated with degeneration of nerve cells within the wall of the oesophagus.

How is it diagnosed?

The best way to diagnose the condition is by using a technique called oesophageal manometry.

This involves measurement of the pressure generated within the oesophagus during swallowing, which can help to confirm the lack of peristalsis and failure of relaxation of the lower oesophageal sphincter.

Additional investigations include a barium swallow, a specialized x-ray test which involves swallowing liquid containing barium.

This helps to identify oesophageal widening, a lack of peristalsis and evidence of narrowing at the lower end of the gullet, often termed a beak deformity.

A chest x-ray is another useful investigation as it may help to identify the presence of a widened oesophagus.

How is it treated?

The most effective treatment is a technique known as endoscopic dilatation.

This involves the introduction of a small balloon which is inflated and used to rupture the muscular fibres of the lower oesophageal sphincter.

Research suggests this procedure has a success rate of approximately 80%.

Another possible treatment is to inject botulinum toxin into the sphincter.

Botulinum prevents the release of acetylcholine (a substance responsible for muscular contraction) and the lower oesophageal sphincter to relax.

Drug therapies exist and include the use of calcium channel blockers and nitrates to help relax the lower oesophageal sphincter.

Surgery to divide the muscular fibres where the oesophagus meets the stomach is another option. This procedure - a Heller's myotomy - helps relieve symptoms in up to 90% of patients.

However, it can lead to complications, such as gastro oesophageal reflux disease, in which stomach acid comes up into the oesophagus.

What are the complications?

The major complication of achalasia is an increased risk of oesophageal cancer.

By Dr Neel Sharma