Achalasia is the condition in which the lower esophageal sphincter (LES), a
valve that opens and closes to allow food into the stomach, loses its ability to
relax and stays closed. The result is that food and liquid collect in the
esophagus, sometimes causing regurgitation. Over time, the esophagus, or food
tube, will dilate, which can lead to complications. The disorder is
characterized by loss of the wave-like contraction of smooth muscles that forces
food through the digestive tract, peristalsis. The condition can also
include spasms of the LES, and is caused by a lack of nervous stimulation of the
esophagus. If not treated, achalasia can lead to cancer of the esophagus in very
rare cases. Sometimes the opposite can also occur; a cancer occurring in the
esophagus can impair nervous function and lead to a "secondary"
achalasia. Signs of achalasia can include difficulty in
s
Treatment
Options for therapy for achalasia include stretching the lower
esophageal sphincter muscles using a pneumatic dilator. It is a stiff
balloon that is expanded until it opens the LES by partially disrupting, or
ripping, these muscles. This is usually done on an outpatient basis in a
hospital under X-ray guidance and with a sedative, while you are conscious. The
risk of perforation with this procedure has been cited from two to twelve
percent. If the dilator perforates the esophagus, intravenous antibiotics
and/or surgery may be required to repair the injury. For some people with
achalasia, however, even multiple dilation attempts are unsuccessful, and
surgical myotomy, where the muscle is cut surgically, may be needed. This
procedure, which requires general anesthesia and several days of
hospitalization, may result in problems with gastroesophageal reflux, due to the
fact that the lower esophageal sphincter is damaged by design during the
procedure. Advanced centers can now attempt the procedure laparoscopically,
dramatically cutting down the recovery times involved.
One treatment uses a medication called botulinum toxin, or Botox(R), injected
directly into the esophagus. Botulinum toxin acts on the nerves that
regulate the lower esophageal sphincter, causing the sphincter to relax.
Although its long-term results are not yet known, botulinum toxin has proven
effective for several months to over a year at a time. This treatment's main
drawbacks include its short duration as well as the ability of repeated
treatments to produce an undesired reaction called tachyphylaxis, where the
patient pay experience unwanted effects from a repeat exposure to the
compound. Repeat treatment is often needed at regular intervals after the
first.
The outlook for those who suffer with achalasia is good, although more
than one session of esophageal dilation may be needed over the course of several
weeks to adequately lower LES pressure to prevent blockage of the passage of
foods through the esophagus. Usually, dilatation brings a permanent cure.
However, as noted, the effect of botulinum toxin may wear off after several
months; the medication's long-term success is not established, and the problem
can come back over time. It is wise to discuss options available, their
risks and benefits, thoroughly with your doctor.
