Have you ever felt like your food is stuck in your chest instead of going down your stomach? Or maybe you feel like it keeps coming back up your throat after drinking a little water? It's normal for this to happen occasionally. But if it continues, it's not something we can ignore. Today, we're going to talk about a condition that causes such discomfort, but is not very well known. That's Achalasia.
Simply put, what is Achalasia?
Achalasia is a rare condition that affects our esophagus. To understand this very simply, let's first look at how our esophagus normally works.
Imagine that our esophagus is a tube made of muscles that runs from our mouth to our stomach (stomach). When we swallow food, the muscles in this tube contract from top to bottom in a wave-like motion (this is called peristalsis in medical terms), pushing the food ball down.
At the very bottom of this esophagus, where it connects to the stomach, there is a ring of muscle that acts like a valve. We call this the Lower Esophageal Sphincter (LES) . It's like a door. This door (LES) opens at the right time when the food ball comes down, and after the food goes into the stomach, it closes tightly again. Because of this closure, the stomach acids don't come back up into the esophagus.
Now, a person with Achalasia experiences two disturbances in this process.
1. The muscles in the esophagus are not working properly: The wave-like process that pushes food down (peristalsis) I mentioned is not happening properly. Either it doesn't happen at all, or it happens very weakly.
2. The lower esophageal sphincter (LES) does not open: Even though food is coming down, the valve-like part that is supposed to enter the stomach (LES) does not open as it should. It remains tight.
So imagine, the food doesn't get pushed up, and the door doesn't open at the bottom. What happens then? All the food and drink we swallow gets stuck inside the esophagus. It doesn't go into the stomach. That's basically what happens in Achalasia.
This condition affects only about one in 100,000 people in countries like the United States. That means it's very rare. It usually affects adults between the ages of 25 and 60, but it can sometimes affect people younger than that.
What are the symptoms of someone with Achalasia?
The symptoms of achalasia don't appear all at once. They come on very gradually. You may have the condition for months or even years, but you may not notice much difference. The symptoms only get worse over time.
Let's see what these symptoms are in the table below.
| Symptom | A simple explanation |
|---|---|
| Difficulty swallowing (Dysphagia) | This is the main and most common symptom. It feels like there is a blockage in the throat or chest when eating. At first, it only affects solid foods, but later on, this discomfort can occur when drinking liquids as well. |
| Regurgitation (food coming back up into the throat) | Swallowed, undigested food coming back up into the mouth. This is not the same as vomiting. It does not taste sour because it has not been mixed with stomach acids. This can happen especially while sleeping. |
| Chest pain | Chest pain that comes and goes can occur. Some people may even mistake this for a heart attack. |
| Weight loss | Because food does not enter the stomach properly and because of the difficulty in eating, the body starts to lose weight for no reason. |
| Other features | Difficulty swallowing, heartburn, and frequent hiccups may also occur. |
Why is this happening? What is the reason?
In fact, doctors still aren't 100% sure what causes Achalasia. But one of the main theories is that it's an autoimmune disease .
Simply put, it means that our body's defense system (immune system) mistakenly attacks our own good cells. Here's what's believed to happen in Achalasia:
- Our immune system is stimulated by something like a viral infection.
- Then this immune system mistakenly starts attacking the nerve cells that control the function of the muscles in our esophagus.
- Due to this attack, those nerve cells are gradually destroyed.
- When those nerve cells are lost, the muscles in the esophagus don't get the signals to contract properly. And the lower esophageal sphincter (LES) doesn't get the signals to relax. That's what causes this problem.
The most important thing is that this is not a hereditary or contagious disease. So there is no need to worry about it.
What complications can occur due to this condition?
If achalasia is not treated properly, it can lead to some serious complications. Food and drink that collect in the esophagus can come back up into the throat and accidentally travel up the windpipe into the lungs. If that happens, problems like these can occur.
- Aspiration pneumonia: A severe pneumonia caused by food or drink entering the lungs.
- Lung infections and bronchiectasis: Frequent inhalation of food into the lungs can even cause permanent damage to the lungs.
- Increased risk of esophageal cancer: When achalasia is present for a long time, changes occur in the cells of the esophagus, and the risk of developing esophageal cancer increases slightly more than the average person.
- Malnutrition: Because food is not properly absorbed by the body, the body may become thin and not receive the necessary nutrition.
This is why we say that if you have difficulty swallowing, you should ignore it and see your doctor as soon as possible.
How does a doctor diagnose this disease?
When you go to the doctor, he will ask you about your symptoms and do a physical exam. He will then recommend several tests to confirm whether you have Achalasia. The three most common tests are:
1. Esophagram (Barium Swallow) Test: In this test, you are given a special liquid called barium to drink. This liquid appears white on X-rays. As you swallow it, a series of X-ray pictures are taken. This allows you to clearly see how the liquid moves through the esophagus, whether it is blocked anywhere, whether the esophagus is wide, or whether the lower part is narrowed (this is also called the 'bird's beak' sign).
2. Esophageal Manometry: This is the best and most accurate test to diagnose Achalasia. In this, a very thin, flexible tube is inserted through your nose into your esophagus. While you are asked to swallow a small amount of water, sensors on the tube can accurately measure the pressure of the muscle contractions in your esophagus, whether the wave-like movement (peristalsis) is occurring, and whether the lower esophageal sphincter (LES) is relaxing properly.
3. Upper Endoscopy: In this test , a flexible tube (endoscope) with a camera attached is inserted through the mouth into the esophagus and the inside is viewed directly on a screen. This can confirm whether the esophagus is blocked, whether food is stuck, or whether there are other conditions such as cancer.
What are the treatments for Achalasia?
The main goal of treating achalasia is to relax the tight lower esophageal sphincter (LES), allowing food to pass more easily into the stomach.
The important thing is that these treatments cannot completely cure Achalasia, as the nerve cells that have been lost cannot be regenerated. However, these treatments can help you control your symptoms and lead a normal life .
Treatment options can be divided into two categories: non-surgical and surgical. Your doctor will discuss with you the most appropriate treatment based on your condition, age, and preferences.
| Type of treatment | How to do it and description |
|---|---|
| Nonsurgical Treatments | |
| Balloon Dilation | During an endoscopy, a balloon is inserted through a tube into the narrowed part of the esophagus and inflated. The narrowed muscle relaxes, making the opening slightly larger. This is done under light anesthesia. You may need to do this treatment several times. |
| Medication | Medications can be used to relax the LES muscle. One way is to inject Botox® (botulinum toxin) into the muscle. There are also pills such as nifedipine and isosorbide. However, the effects of these are temporary. |
| Surgical Treatments | |
| Laparoscopic Heller Myotomy | This is the most common and successful surgery. A few very small incisions are made in the abdomen, a camera and delicate instruments are inserted, and the muscle fibers that are tight at the bottom of the esophagus are gently cut and separated from the outside. The tightness is then released and the door is loosened. |
| Peroral Endoscopic Myotomy (POEM) | This is a new technique. Without making any incisions on the outside of the body, an endoscope is inserted through the mouth and the tight muscle is cut from inside the esophagus. |
Very rarely, if symptoms are very severe and other treatments are not successful, surgery to remove the entire esophagus (esophagectomy) may be necessary.
What should I be concerned about after treatment?
Achalasia symptoms may recur after treatment. Therefore, you will need to stay in touch with your doctor for a long time. He or she will regularly check for the following:
- Are you able to pass enough food and drink through your esophagus into your stomach?
- Because the lower door is loosened, a condition in which stomach acids flow back into the esophagus (GERD) has developed.
- Is there a risk of developing esophageal cancer?
This disease will not affect your lifespan, but it definitely requires proper treatment and follow-up .
What should I do while living with Achalasia?
Along with treatment, making small changes to your lifestyle and eating habits can greatly reduce these discomforts.
- Change your eating habits: When you eat, break your food into small pieces, chew it well, and swallow it. Drink plenty of water with your meals. This will help the food stay moist and go down more easily.
- Eat while sitting up straight: Sit up straight while eating. Don't lie down for an hour or two after eating. This will help gravity move the food down.
- Don't eat before bed: Stop eating solid foods at least 3-4 hours before bed. This will give your stomach time to digest the food before you lie down.
- Sleep with your head elevated: Keep your head slightly elevated by using an extra pillow while sleeping. This will reduce the risk of food in the esophagus going into the windpipe.
What foods should I not eat?
A person with achalasia may have difficulty swallowing certain foods. Be especially careful with these types of foods.
- Foods that can get stuck in the esophagus: unpeeled apples, grapes, raw vegetables, stringy or dried meats.
- Foods that can become solid in the esophagus: Things like bread, rice, potatoes, chips, and pasta can stick together in the esophagus and become solid.
- Things that irritate the esophagus: spicy foods, carbonated drinks (like soda), alcohol.
You don't have to stop eating these foods completely, but if you feel uncomfortable, it's best to stay away from them.
Take-Home Message
- Achalasia is a rare condition caused by the muscles of the esophagus and the lower esophageal sphincter (LES) not working properly.
- Difficulty swallowing, regurgitation, and chest pain are the main symptoms.
- These symptoms occur sporadically, so don't ignore even a slight difficulty swallowing.
- Although it cannot be completely cured, surgery and other treatments can successfully control the symptoms and allow people to live a normal life.
- If you have these symptoms, it is very important to see your family doctor as soon as possible for advice.
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