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What is achalasia? Symptoms and Treatment

Monday, October 11, 2021


Achalasia can be defined as the inability of food to pass into the stomach due to the inability of the esophagus, located on the side of the esophagus close to the stomach, to relax.

The most common symptom of achalasia, a movement disorder in the esophagus, is difficulty swallowing. Patients who have difficulty swallowing solid and liquid foods may feel the need to vomit. If the slowly progressing achalasia disease is not treated, serious health problems may occur with the escape of food into the lungs.

What is Achalasia?

Achalasia is a digestive system disease in which the functions that should occur in the esophagus are disrupted. In achalasia, foods accumulate in the esophagus because the lower esophageal sphincter, which opens during the passage of consumed food from the esophagus to the stomach, cannot relax sufficiently. Since the consumed food and drinks cannot pass into the stomach for a long time, patients usually experience nausea and vomiting symptoms. Although achalasia can be confused with reflux due to the food coming into the mouth, it is possible to make an accurate diagnosis by following the esophageal movements with different imaging methods.

Achalasia is a rare disease. This disease, which usually starts in the 20s or 30s, progresses slowly. Achalasia, which is seen almost equally in men and women, is a disease that should not be neglected and treated.

Causes of Achalasia

Achalasia is a disorder that occurs as a result of the death or damage of nerve cells that stimulate the valve system with the act of swallowing. Although it is not known exactly why these nerve cells die, it is thought that autoimmune diseases and diabetes may cause achalasia. Viral diseases and esophageal cancer can also cause this condition.

Achalasia Symptoms

Symptoms of achalasia appear gradually. The first common symptom in achalasia patients is difficulty swallowing solid and liquid foods. There is also the risk of suffocation in this ailment where the food accumulated in the esophagus comes back to the mouth. Other symptoms that can be seen during the course of the disease are as follows:

• Post-meal cough

• Burning and heartburn in the stomach

• Chest pain

• Feeling of fullness in the throat

• Vomiting and gagging

• Belching

• Weight loss

• Pneumonia and bronchitis as a result of the food accumulating in the esophagus entering the lungs.

Achalasia Diagnosis

Achalasia is suspected in patients who apply to the doctor with difficulty in swallowing and some tests are requested for diagnosis. Three different methods are generally used in the diagnosis of the disease. Gastroscopy is one of the most frequently used imaging methods.

In this method, the esophagus is visualized through a tube with a camera at the end. In the method called manometry (pressure measurement), it is possible to diagnose achalasia by measuring the pressure in the esophagus.

In barium X-ray, patients are given a barium-containing substance to drink, and the diagnosis of achalasia can be confirmed if the barium does not pass into the stomach and remains in the esophagus. However, it should not be forgotten that the barium X-ray method should not be applied to pregnant women.

Achalasia Treatment

The methods used in the treatment of achalasia vary according to the stage of the disease and the severity of the symptoms.


Drug treatment is applied in patients with mild symptoms and whose disease is still in the initial stage. Calcium channel blockers (Nifedipine) or nitrates (Isosorbide dinitrate) are taken before meals to reduce lower esophageal pressure. Some side effects can be seen in the long-term use of drugs that improve the recovery of many patients.

Botox Treatment

With botox injected into the lower esophageal sphincter, the muscle, which has become intractable, is forced to relax. The effect of this procedure, which can also be performed during gastroscopy, lasts for 6-12 months. Therefore, in case the symptoms reappear, this process should be repeated with an interval of 1 year.

Balloon Dilatation

In the method called balloon dilatation, dilatation balloons with a diameter of 30-40 mm are placed in the lower esophagus region and inflated. The success rate of the balloon dilation method, which aims to ensure a smooth transition between the esophagus and the stomach, is 70-80%. In this commonly used method, the patient is discharged on the same day. In some patients, this procedure can be applied twice. If there is no improvement with this method, surgical treatment methods are applied.

Surgical treatment

Surgical intervention may be required in patients who do not respond to medication, botox and balloon treatment. In the surgical method called “Heller Myotomy” applied in the treatment of achalasia, a part of the lower esophagus muscle is cut and thus a passageway for nutrients is opened. After the Myotomy method, which can be performed as open or closed, 90% of the patients get rid of all the symptoms of achalasia at the end of the 1st year and 85% at the end of the 5th year. However, since this method may cause reflux, the patient may need to use medication continuously.

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