Achalasia: Are You at Risk for This Rare Swallowing Disorder?

Trouble swallowing can have various causes
Achalasia: Are You at Risk for This Rare Swallowing Disorder?

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.

What’s happening in your body if you have 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:

  • Difficulty swallowing.
  • Vomiting undigested food.
  • Chest pain.
  • Heartburn.
  • Weight loss.

Who is at risk?

It’s difficult to predict who is at risk for achalasia.

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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.

What causes this problem?

“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.

How do doctors treat achalasia?

We can’t cure achalasia, but we can control its symptoms, Dr. Murthy says. There are several treatment options.

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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:

  • Heller myotomy. In this minimally invasive operation, the surgeon cuts the muscles of the valve between the esophagus and the stomach. This allows food to pass through. This technique, which requires only five small incisions, is often the best option, he says.
  • Peroral endoscopic myotomy (POEM). This innovative procedure involves cutting the muscles from inside the esophagus. It takes between one and three hours, Dr. Murthy says
  • Botulinum toxin (Botox®) injections. These are often used to treat older patients or those who shouldn’t risk surgery. The injections can relax the lower esophageal muscles and keep them from contracting. They offer a temporary fix, and are sometimes repeated.
  • Endoscopic balloon dilation. This is a temporary treatment which disrupts the muscles and widens the opening to allow food to enter the stomach.

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.

Can achalasia cause cancer?

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.

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