Achalasia: Are You at Risk for This Rare Swallowing Disorder?
Achalasia is a rare disorder that causes people to have trouble swallowing their food. Find out more about how several treatment options can help control the symptoms.
Do you sometimes struggle to swallow your food when you eat? Does it feel like it just gets stuck on the way down? If this happens more than occasionally, you should talk to your doctor.
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Trouble swallowing can be related to common problems, such as gastroesophageal reflux disease (GERD). Or it can be related to a rare, but more serious swallowing disorder called achalasia.
The first symptoms of achalasia are often subtle. Maybe you’re chewing a piece of bread and you find that you need a gulp or two of water to get the food down. You might dismiss the problem at first. But then it becomes increasingly difficult to swallow food and even to drink liquids.
“Patients often feel as if it is a sudden onset. But achalasia is a slow and progressive swallowing disorder that patients only recognize at later stages,” says Sudish Murthy, MD, Section Head of Thoracic Surgery and Surgical Director of the Center of Major Airway Disease at Cleveland Clinic.
The problem is with your esophagus, the muscular tube that connects your throat to your stomach. Dr. Murthy answers four questions to explain what you need to know about achalasia.
Achalasia occurs when the muscle at the lower end of the esophagus (the lower esophageal sphincter) fails to relax when you swallow. This prevents the food from entering your stomach. The food then backs up, and you begin to notice symptoms such as:
It’s difficult to predict who is at risk for achalasia.
It’s a relatively rare condition. It affects about 3,000 adults and children in the United States each year. It seems to occur randomly across races and ethnic groups, and does not run in families.
“It cuts across the spectrum of ages, with a concentration in middle-age people,” Dr. Murthy says.
“This is one of those diseases for which the cause is largely unknown, with significant conjecture and hypothesis,” Dr. Murthy says.
One theory is that the disease relates to a viral infection.
The infection may damage the nerves that allow the lower esophageal sphincter to relax. The immune system may attack these nerves, which then slowly degenerate.
We can’t cure achalasia, but we can control its symptoms, Dr. Murthy says. There are several treatment options.
Medication can help relax the lower esophageal sphincter, but this treatment has only marginal success, he says.
Most patients with achalasia undergo a procedure or surgery. The most common options include:
Whatever your treatment, you should follow up with your doctor at least once each year, Dr. Murthy says.
“Often these interventions can palliate the disease for a lengthy amount of time, but the view needs to be long-term,” he says.
People with achalasia have a slight increased risk of developing esophageal cancer, particularly if the obstruction has been a problem for a long time.
Difficulty swallowing is a symptom of both achalasia and esophageal cancer, so your doctor will rule out cancer before treating your achalasia, Dr. Murthy says.