Cliff Carlson Law Blog

What is Esophageal Achalasia?

Esophageal Achalasia is a disease that affects the muscle of the lower esophageal body and the lower esophageal sphincter. The lower sphincter is unable to relax and allow food to enter the stomach. The muscles of the esophagus may also have trouble getting food to that lower sphincter. Both make swallowing food very difficult. The effect of this may be more profound when eating dryer food and when consumer less liquid during a meal.

The main symptoms of achalasia are difficulty in swallowing, regurgitation of undigested food, chest pain, cough, intense pain or discomfort after eating, and unintentional weight loss. The difficult in swallowing tends to become progressively worse over time and to involve both fluids and solids. Some people may also experience coughing when lying in a horizontal position. The chest pain can often be mistaken for a heart attack and can be extremely painful in some sufferers. Food and liquid, including saliva, may be retained in the esophagus and may be inhaled into the lungs

To diagnose achalasia, doctors may take x-rays while the patient is taking barium. This x-ray can show irregularities in the rhythmic waves in the esophagus, or a widening of the lower sphincter. They may also use esophageal manometry. This involves having a tube placed in your esophagus while you swallow. The tube records the muscle activity and makes certain everything is working correctly. An X-ray, or similar exam, of your esophagus may also be used to diagnose this condition. Other doctors prefer to perform an endoscopy. In this procedure, a small camera, at the end of a flexible tube, is put into the esophagus to look for problems. During this procedure the doctor may remove some tissue for further examination. This biopsy will help check for cancer.

Most esophageal achalasia treatments are aimed at the lower esophageal sphincter. Several types of treatment can be used to either temporarily reduce your symptoms or permanently alter the function of the valve. The first line of treatment is often oral medications such as Nitrates, or even Botox, that can help to relax the lower sphincter so food can pass through it more easily.

For a more permanent solution, doctors may try to dilate the sphincter or alter it. Dilation, which widens the sphincter mechanically, is usually done by inserting a balloon into the esophagus and inflating it. This stretches out the sphincter and helps the esophagus function properly. Repeated dilation procedures are not uncommon, and sometimes dilation tears the sphincter. This can result in death if not treated appropriately.

Esophagomyotomy is another option. Doctors use a large or small incision to access the sphincter and carefully alter it to allow better flow into the stomach.

 

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