The digestive system takes part in the removal of unused food residues from the body by digesting the energy resources taken into the body through nutrition and separating them into building blocks to be used to obtain energy. The food consumed is transferred from the throat to the esophagus (esophagus) and from there to the stomach by swallowing. The stomach secretes acidic gastric acid containing digestive enzymes. A sphincter is located between the stomach and the esophagus to prevent stomach acid and food content from escaping back into the esophagus. This sphincter, called the lower esophageal sphincter, normally opens with swallowing and allows the passage of food to the stomach. In individuals with achalasia, this sphincter loses its function for any reason. Achalasia, which can cause chest pain and some other long-term side effects, especially after meals, is a health problem that needs attention and treatment.
Achalasia is a digestive system disease characterized by the accumulation of swallowed bites in the esophagus due to the sphincter between the esophagus and the stomach not opening properly. The lower esophageal sphincter, which normally opens with swallowing, cannot be opened due to neural damage or sphincter muscle disorders in individuals with achalasia. This causes discomfort in the chest by causing dysphagia and a feeling of food compression in the esophagus. Since the risk of aspiration increases, there is a risk of ingested food entering the esophagus and choking. Achalasia disease, which usually affects adults in the middle and advanced age group, may rarely occur in childhood. The symptoms of achalasia, which is not a very common disease, can be confused with different diseases in some cases. Therefore, the patient should express the health problems experienced and the style of the symptoms he feels to the physician. Some individuals confuse achalasia with gastroesophageal reflux (stomach reflux). This is because in both diseases, there is a symptom such as the food that is swallowed back into the mouth. However, although both of them are caused by a problem related to the function of the lower esophageal sphincter, in reflux disease, there is a leak of stomach contents into the esophagus, while in achalasia, there is a difficulty in passing the food in the esophagus to the stomach.
What are the symptoms of achalasia?
The most common symptom seen in people with achalasia is difficulty swallowing. Most of the patients complain of the feeling that something is caught in their throat or esophagus. This condition, also called dysphagia, brings along problems such as cough and throat irritation. There are also risks of aspiration and suffocation. Symptoms seen in achalasia patients are usually not so severe in the initial stages. However, the severity and frequency of the problems may gradually increase. Over time, patients may begin to have serious difficulty swallowing solid foods. Apart from these, other symptoms of achalasia can be listed as follows:
• Chest pain and discomfort
• Burning in stomach and chest
• Feeling pain and discomfort after meals
• Gagging or vomiting
• Pneumonia (in patients with aspiration)
• Weight loss
There are different factors that can play a role in the development of achalasia. One of them is heredity. Individuals with achalasia or a different stomach disease in their family are more likely to have this disease than other individuals. In addition, the likelihood of achalasia disease increases in individuals with autoimmune diseases. This is because the nerves in the lower esophageal sphincter can be damaged in autoimmune diseases that cause the body to damage its own tissues. Esophageal cancers and some parasite-borne diseases can also lead to the emergence or exacerbation of achalasia. Another factor that is thought to play a role in the development of the disease is viral diseases. Although many opinions agree that the main cause is nerve cell damage, the exact cause of achalasia has not yet been determined. Scientific research on this subject is still ongoing.
Physicians may suspect achalasia together with some other digestive system diseases in patients who admit to health institutions with symptoms such as vomiting, chest pain, dysphagia, feeling of food accumulation in the esophagus, weight loss. The diagnosis, treatment and follow-up procedures of this disease are carried out by the gastroenterology units of the hospitals. Patients’ difficulty in swallowing both solid and liquid foods and the problems experienced worsening over time are among the findings that strengthen the possibility of achalasia. Esophageal manometry is one of the diagnostic methods that can be used in the diagnosis of achalasia. In this procedure, a special tube is placed in the esophagus while swallowing and the activity of the lower esophageal sphincter is investigated. Whether the sphincter is functioning properly can be determined easily with this method. X-rays or different medical imaging tests can be preferred for examining the esophagus and investigating possible disorders. In addition to esophageal manometry, another diagnostic method is the endoscopy method, which is frequently used in medicine and especially in gastroenterology. In endoscopy, a tube (endoscope) with a light and camera at the end is placed in the digestive canal and the entire digestive canal up to the duodenum can be viewed by entering from the oral cavity. In the less used barium swallowing method, patients swallow liquid form barium and the progress of barium in the digestive tract is monitored using X-rays. Therefore, in case of any disorder or blockage, information about the problem can be obtained.
In the case of paralysis caused by nerve damage in the lower esophageal sphincter, there is no treatment method that allows the muscle to regain functionality and function properly. However, with some treatment practices, the symptoms associated with the disease can be significantly reduced. At the same time, it may be possible to achieve permanent changes in sphincter function to relieve symptoms with the help of surgical interventions. The first method of treatment is usually called pneumonic dilatation or balloon dilatation. In this treatment method, which allows the lower esophageal sphincter to be expanded, a special balloon is placed in the esophagus and inflated. This process helps the sphincter to elongate and expand, thus helping the esophagus to function better. In some cases, as a result of the procedure performed, tears may occur due to enlargement in the sphincter. In this case, different surgical operations may be required to repair the sphincter. Esophagomyotomy (percutaneous esophageal myotomy) operation is another treatment method used in patients in whom dilatation does not yield successful results. In esophagomyotomy, a small incision is made to reach the sphincter and this area is enlarged by cutting the muscle at the lower end of the esophageal sphincter. Gastroesophageal reflux disease may develop due to loosening of the sphincter in some of the patients undergoing esophagomyotomy. In this case, problems related to reflux such as heartburn, stomach acid coming into the mouth or nausea may occur. Achalasia treatment can also be performed with minimally invasive surgical applications called Heller myotomy. The most important advantage of this operation, which is performed by opening five small incisions, is the reduction of the possibility of reflux in the postoperative period with the help of a technique called partial fundoplication. In patients who are not suitable for surgery, muscle relaxant drug treatments or botox (botulinum toxin) injections to help relax the lower esophageal sphincter can be applied.
However, these procedures are the treatment options that can be preferred only in patients who are not deemed appropriate due to reasons such as illness or advanced age and do not provide permanent benefit. In patients who are eligible for surgery, the first option is the dilatation method. Surgical operations treat up to 95% of the adverse events associated with achalasia. In a small number of patients, the balloon method or surgical operation techniques should be repeated. In order to prevent the need for new interventions, patients should pay attention to their diet and preventive measures recommended by their physicians.