Achalasia

Hiatus Hernia :: Achalasia

Achalasia, is a disorder of the oesophagus where the lower oesophageal sphincter doesn't relax properly with swallowing. The oesophagus is less able to move food toward the stomach and the valve from the oesophagus to the stomach does not relax as much as it needs to during swallowing.

Under normal circumstances, when you swallow, food is passed down the oesophagus by waves of muscle contractions and into the stomach.

Lower oesophageal sphincter

A 'valve', which doctors call a sphincter, controls the entry of food from the lower end of the oesophagus into the stomach. This particular sphincter is known as the lower oesophageal sphincter. It is a band of muscle that opens to allow the food to pass from the oesophagus down into your stomach and then closes again to prevent the acidic stomach contents from coming back up.

In achalasia the lower oesophageal sphincter doesn't relax properly with swallowing, which means that food is not pushed down into the stomach. Instead, it becomes lodged in the oesophagus. This happens because achalasia affects the nerves that control the sphincter muscles.

Another feature of achalasia is that the normal rhythmic contractions of the oesophagus, which propel food down it towards the stomach (doctors call this peristalsis), are lacking. Doctors think that this may be due to a malfunction of the nerves that encase the oesophagus.

Achalasia can happen at any age, but begins most often between 20 and 40 years of age. It can start almost unnoticed, gradually advancing over a long period.

Complications

• Tearing (perforation) of the oesophagus
• Regurgitation of acid or food from the stomach into the oesophagus (reflux)
• Aspiration of food contents into the lung that can cause pneumonia

Treatment

The approach to treatment is to reduce the pressure at the lower oesophageal sphincter. This may be achieved by manipulating the lower esophagus sphincter with special instruments.

Medications can also be used to lower the pressure at the lower esophagus sphincter.

Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.