ACHALASIA: WHAT IS ACHALASIA?
Definition: What is "Achalasia"?
Achalasia also called esophageal achalasia; cardiospasm, achalasia cardiae; dyssynergia esophagus or esophageal aperistalsis; is an esophageal motility disease. This disorder manifests an impaired peristalsis of the smooth muscle level of the esophagus. Peristalsis is the term used to describe the muscular capability of the esophagus to make the food move down to the stomach). Also, a patient with achalasia has a lower esophageal sphincter or LES that cannot relax which is its normal response to swallowing. The most common form of this disorder is primary achalasia. This form has no recorded underlying cause. Esophageal cancer (Chagas disease in South America) could be a result of achalasia.
Symptoms & Signs
There are many symptoms of achalasia: dysphagia or difficulty in swallowing food; coughing (more so when the patient reclines or lies down); regurgitation of food that hasn't been digested yet; loss of weight because of insufficient food intake; heartburn; belching difficulties; NCCP or non-cardiac chest pains which may also affect the jaw, back, neck & arms; recurrent hiccups.
Achalasia has so many symptoms that are similar to many other illnesses that's why it is hard to diagnose or it can easily be misdiagnosed. Other disorders that have similar symptoms include GERD or gastroesophageal reflux disorder; psychosomatic disorders, or hiatus hernia. To properly investigate the presence of achalasia, it is imperative to undergo x-ray (that comes with barium swallow) or esophagography. The physician or radiologist makes the patient swallow some barium solution which would fail to pass easily through the lower part of the esophageal sphincter. The physician will then be able to point out a margin of air fluid over the column of barium because of the absence of peristalsis. The 'rat tail' or 'bird's beak' would appear on the lower esophagus. Five minutes should be enough to give the doctor a thorough observation. Manometry is the most important factor in establishing the achalasia diagnosis. A probe will measure the waves of pressure in various esophageal portions (also that of the stomach's) during the swallowing stage. Here, a thin tube will be placed through the nose & the doctor will instruct the patient to swallow more than once. Endoscopy is a good test to view the actual state of the esophagus & the stomach. A very tiny camera is put through the patient's mouth while he is sedated. The endoscopist will examine a 'pop' when the scope will pass through the lower esophageal sphincter which would not relax. CT scan is best done to rule out the possibility of esophageal cancer.