Achalasia


Esophageal motility disorder



Normal

Abnormal
  • Achalasia is a disorder in which the normal wavelike movements of the smooth muscles of the esophagus (i.e. peristalsis) -- which help to propel food along -- do not work properly.
  • In addition, the lower esophageal sphincter (i.e., LES) -- the opening between the esophagus and stomach -- does not open properly because it cannot relax when swallowing, resulting in spasms.  These two problems create difficulty or inability to swallow solid food.  The ability to swallow liquids may be affected as well.

  • Tests that might be done:
  • Chest X-Ray may show a fluid-filled esophagus
  • Barium swallow
  • Endoscopy (physician looks with camera scope into esophagus)
  • Esophageal manometry (special test for evaluating proper function and pressure in the esophagus)
  • Blood tests may show anemia.

  • Botulism toxin injection -- this is done in the esophageal sphincter (connection between the esophagus and stomach).  This relaxes the esophageal sphincter and allows food/liquids to pass more easily.
  • Medications such as Calcium channel blockers and nitrates can help in some cases to lower LES pressure.
  • Pneumatic dilation -- a balloon is inflated to open the esophageal sphincter so food/liquid can pass more easily.
  • Surgical myotomy -- the muscles of the esophageal sphincter are cut, allowing food/liquid to pass.  This is usually only done when the above treatments fail.