Achalasia – SP Medifort Hospital

Achalasia Treatment

Achalasia Treatment In Trivandrum

Achalasia is a rare swallowing disorder that affects the esophagus (the tube between the throat and the stomach). In people with achalasia, the esophagus muscles don’t contract properly and don’t help propel food down toward the stomach. At the same time, the ring of muscle at the nethermost end of the esophagus, called the lower esophageal sphincter (LES), is unable to relax to let the food into the stomach. Achalasia generally affects adults between 30 and 60 years of age, with a peak in the 40s. The disease is about doubly as common in men than women.

Symptoms and Causes

What are the symptoms of achalasia?

Achalasia symptoms generally develop gradually and worsen over time. Symptoms may include:

Difficulty swallowing, called dysphagia, may feel like food or drink is stuck in the throat
Swallowed food
Heartburn
Spewing
Chest pain that comes and goes
Coughing at night
Pneumonia from getting food in the lungs
Weight loss
Vomiting

Different types of achalasia

The way muscles in the esophagus malfunction in people with achalasia varies. In all cases of achalasia, the lower esophageal sphincter that controls the passage between the esophagus and the stomach fails to relax at the right time. predicated on other problems that are at the same time, doctors identified three types of achalasia.

Type 1 achalasia: sometimes called classic achalasia. With this type, the esophagus muscles slightly contract, so food moves down because of stasis alone.
Type 2 achalasia: pressure builds up in the esophagus, causing it to become compressed. This is the most common type of achalasia, and it constantly causes more severe symptoms than type I.
Type 3 achalasia: sometimes called spastic achalasia because there are abnormal condensations at the bottom of the esophagus where it meets the stomach. This is the most severe type of achalasia. The condensation can cause chest pain that can awaken a person from sleep and imitate the symptoms of a heart attack.

What Causes Achalasia?

The causes of achalasia are unknown, but researchers are exploring several theories.

Nerve cell damage in the esophagus : Loss of the nerve cells that control esophageal muscle movement and the lower esophageal sphincter (LES) leads to poor muscle coordination and an LES that fails to relax properly. This nerve damage is the key underlying factor in achalasia.
Autoimmune processes : Some experts believe the body’s immune system may mistakenly attack its own esophageal nerve cells, contributing to nerve degeneration and achalasia development.
Viral infections : Viral infections are thought to possibly trigger inflammation and damage to esophageal nerves, leading to achalasia in susceptible individuals.
Genetic factors : In rare cases, achalasia may be linked to inherited genetic conditions or disorders that affect nerve function, suggesting a genetic predisposition.

Diagnosis of achalasia

In addition to a physical exam and review of symptoms, your doctor may recommend specific tests to diagnose achalasia.

Esophageal Manometry: Esophageal manometry is the gold standard test for achalasia and measures the pressure and coordination of esophageal muscle contractions during swallowing. It typically shows absent peristalsis and impaired relaxation of the lower esophageal sphincter (LES), confirming the diagnosis.
Barium Swallow : A barium swallow (esophagram) is an X-ray test in which the patient drinks a contrast liquid that coats the esophagus, allowing its shape and function to be imaged. In achalasia, this often reveals a dilated esophagus with a “bird’s beak” narrowing at the LES and delayed emptying, suggesting the disorder.
Upper Endoscopy : An upper endoscopy uses a tiny camera on the end of a flexible tube to visually examine the esophagus, stomach, and beginning of the small intestine. It helps identify partial blockages or narrowing of the esophagus and rules out other causes of swallowing problems. During the procedure, doctors can take tissue samples (biopsies) to test for complications such as inflammation or Barrett’s esophagus and assess damage from reflux or other conditions.
Functional Luminal Imaging Probe (FLIP): FLIP is a newer test done during sedated endoscopy that uses a fluid-filled balloon with sensors to measure the diameter and distensibility of the esophagus and lower esophageal sphincter (LES) in real time. It helps assess how well the LES opens and can support or confirm an achalasia diagnosis when results from manometry or a barium swallow are unclear by showing abnormal esophagogastric junction function.

Achalasia risk factors

Risk factors for achalasia include:

Age: Achalasia affects persons of all ages, but those between the ages of 25 and 60 are more likely to have it.
Certain health issues: Individuals with allergic illnesses, adrenal insufficiency, or Allgrove syndrome—a rare autosomal dominant heritable condition—are more susceptible to achalasia.

Treatment options available for achalasia

Achalasia currently has no known cure, although there are some treatment options, including

Dilation of the Esophageal Sphincter: Dilation is a common achalasia treatment that widens the tight lower esophageal sphincter (LES) using a balloon inserted through an endoscope while you are asleep, helping food and liquids pass more easily into the stomach. Success rates for balloon dilation are generally high (often around 70–80% or more), and many patients notice improved swallowing, though symptoms can return over time, and repeat treatments may be needed. It is a well-established, minimally invasive option before considering surgery.

Botulinum Toxin Injections: Injecting botulinum toxin into the lower esophageal sphincter (LES) can help some people with achalasia by relaxing the tight muscle and improving swallowing. The injection is done through an endoscope and works by blocking nerve signals that make the muscle contract. Botox is especially useful for older patients or those who cannot have balloon dilation or surgery due to other health issues. The relief is temporary—often lasting about 6 to 12 months—and repeat injections may be needed, though
repeated treatments can make later surgery more difficult. Some patients may feel mild chest discomfort, and symptoms usually improve within days after the procedure.

Medications for Achalasia : Medications are generally not very effective in treating achalasia and are usually reserved for people who cannot have more definitive treatments like dilation or surgery. Certain drugs, such as calcium channel blockers (e.g., nifedipine) and nitrates, can temporarily relax the lower esophageal sphincter (LES) and may help ease symptoms when taken before meals, but their benefit is short‑lived and limited, and side effects like headache, low blood pressure, dizziness, or swelling often outweigh the advantages. Because of this, medication is usually a temporary option rather than a long‑term solution for achalasia.

To know more about achalasia and avail expert opinions, consult our gastroenterology team.