Have you ever experienced difficulties with swallowing? You know, the feeling that swallowed food is stuck in the chest, maybe you have to eat slowly, sometimes it's easier to eat if you lift your neck... If you have those symptoms go and see your doctor to check for achalasia, a rare but very unpleasant health disorder.
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Symptoms may also include chest pain, regurgitation of swallowed food, difficulty burping, heartburn, a sensation of fullness, hiccups, and even weight loss.
Achalasia is a swallowing disorder that occurs in about 1 in every 100,000 people. It happens when nerve cells in the tube that carries food from the mouth to the stomach (esophagus) don't work as they should, they degenerate over time, and they don't send signals for muscles to contract. If muscles don't contract, they don't send the food into the stomach. As you imagine, that is bad because food has its place in the stomach, not somewhere else where it can cause problems.
Now, at the lower end of the tube that carries the food to the stomach there are muscles that contract and squeeze the end of the tube. That prevents the stomach contents from flowing back. In patients with achalasia those muscles do contract but don't relax. The consequence: they prevent anything you eat or drink to enter your stomach. That food accumulates at the bottom of the tube which is not good too.
Now the bad news: in most people achalasia is diagnosed somewhere at the ages of 25 to 60, meaning it can strike anytime. More bad news is that it gradually gets worse and people somehow manage to eat until symptoms are so severe that it's clear to anybody that the doctor is a must. While we're at bad news, let's add that this condition can't be cured.
Now the good news. The symptoms can usually be controlled with treatment. But first we must confirm the condition.
Chest x-rays can show is esophagus dilated and what's the situation in the stomach. But, this is not enough and we must do further test. We will now use the barium swallow test. This is a screening test for achalasia: the patient swallows a mixture of barium while x-rays are taken. It doesn't taste like good barbeque but it gives results: x-rays can show how that famous tube to the stomach actually looks like, are there spastic contractions in the esophagus (vigorous achalasia), and how much esophagus is dilated.
There is also a test called esophageal manometry, a method that measures changes in pressures in the esophagus. Not very pleasant because it involves a thin tube passed through the mouth or nose into the esophagus. This test can give us a confirmation that it's about achalasia. While at tubes, endoscopy can also be used in search for achalasia conditions.
Now, what can we do about it? Well, the condition can't be cured, stopped and healed. That's understandable because nobody, for now, can bring back lost nerve cells. So, we must focus on symptoms. With the treatments we are trying to weak the lower esophageal muscle so that it no longer poses a barrier to the food. We can use drugs or surgical procedures.
Drugs can make symptoms milder and they are usually taken before meal. Sounds good but some patient can't stand those drugs, and the drugs can be less effective over time. So, they are used in patients with other health conditions, while otherwise healthy patients are advised to try other approaches.
First, we can try with balloon dilation. That's simple: the patient swallows a balloon that is positioned in the problematic place, and the balloon is then inflated very fast. The results: the muscle of the lower esophagus is teared and the food can flow freely. Obviously, you can't repeat that procedure too often. And it is not without dangers because sudden balloon inflation can make a hole where we don't want it.
If all that doesn't help, we can try surgery. Myotomy is a procedure during which the surgeon cuts some muscle fibers.
The point is, if achalasia is confirmed, the doctor must become a friend of the house. The patient must be checked regularly, we must pay attention to acid reflux, watch for other complications, and act as soon as the patient spots them. Achalasia is not a "treat and go" condition, but we can make patient's life much easier and prevent other serious consequences. ■