Achalasia

Achalasia: symptoms, causes, and diagnosis

Understanding Achalasia: Key Aspects of Symptoms and Causes

Achalasia is a disorder of esophageal peristalsis, characterized by incomplete relaxation of the lower esophageal sphincter and aberrant activity of the esophageal body. This pathological condition leads to difficulty in the passage of food into the stomach, which may manifest as regurgitation, dysphagia, and chest pain. The causes of achalasia can be numerous, including degenerative changes in the nerve cells of the esophagus or disorders of neuromuscular coordination.

To understand achalasia, it is important to consider both the physical and psychological aspects that influence the development and course of the disease. Diagnosis of this pathological process may include clinical examinations, endoscopic, and radiological methods, which allows for the determination of the optimal treatment strategy and provision of proper care for the patient.

Factors contributing to the development of Achalasia

To date, the causes of achalasia remain not fully understood, but there are various theories indicating disturbances in the function of the cardia and the nervous mechanisms of digestion. According to some researchers, achalasia may be associated with defects in the nervous system that control the work of the esophageal muscles. Other hypotheses suggest an immunological nature of the disease related to autoimmune processes.

Factors contributing to the development of achalasia include possible genetic predispositions, the influence of external agents, and environmental factors. A number of studies suggest a potential role of infectious agents in the pathogenesis of achalasia. Some studies also propose the influence of the patient’s psycho-emotional state on the development of the disease.

  • Genetic factors: Some studies indicate a possible hereditary influence on the development of achalasia, although specific genes have not yet been identified.
  • Nerve disorders: Disorders of the nervous system that control the muscles of the esophagus may contribute to the onset of achalasia.
  • Autoimmune processes: Immunological disorders may be related to the development of achalasia, including possible autoimmune reactions to the body’s own tissues.
  • Infectious agents: Some studies suggest that infectious agents may play a role in the pathogenesis of achalasia, although the exact mechanisms of this process are still being studied.
  • Psychoemotional factors: Some studies suggest that stress and the psychoemotional state of the patient may influence the development of achalasia and its symptoms.

The main signs and manifestations of Achalasia

Achalasia is characterized by dysfunction of the esophageal cardia, leading to difficulty in the passage of food into the stomach. The main symptom is dysphagia, that is, difficulty swallowing, which usually occurs when consuming solid food or food that requires good chewing. Patients may experience a feeling of food stuck in the chest or throat, which may be accompanied by pain behind the sternum and regurgitation of undigested food.

Other characteristic symptoms of achalasia include regular nighttime cough, a feeling of bloating after eating, weight loss due to difficulty in eating, as well as possible complications such as aspiration and pneumonia. Patients may also experience acid reflux from the stomach into the esophagus due to impaired cardia function, which can lead to irritation of the esophageal mucosa and discomfort in the chest area.

  • Dysphagia: the main symptom of achalasia is difficulty swallowing, which most often manifests when consuming solid food.
  • Feeling of food stuck: patients may experience the sensation of food being stuck in the chest or throat after eating, accompanied by discomfort.
  • Night cough: regular bouts of coughing at night can be one of the signs of achalasia, caused by aspiration of food.
  • Abdominal bloating: patients often complain of a feeling of bloating and discomfort in the abdomen after eating due to the difficulty of food passing through the esophagus.
  • Acid reflux: due to impaired cardiac function, food and acid may be regurgitated from the stomach into the esophagus, causing discomfort and reflux.

Approaches to the treatment of Achalasia: expert opinion

Experts agree that the choice of treatment method for achalasia should be based on the individual characteristics of the patient, the stage of the disease, the presence of complications, and other factors. Traditionally, initial therapy involves methods aimed at reducing the spasm of the cardia and improving the passage of food through the esophagus. This can include medications such as nitrates and calcium channel blockers, as well as methods for dilating the cardiac sphincter or injections of botulinum toxin.

However, in cases where conservative methods do not provide the desired effect or the patient encounters complications, surgical intervention may be required. Experts note that surgical treatment of achalasia, such as laparoscopic myotomy of the cardia or esophageal dilation, can provide long-term relief of symptoms and improve the quality of life for patients.

The process of diagnosing Achalasia

For the diagnosis of achalasia, various methods are used, including esophagogastroduodenoscopy (EGD) and functional tests such as esophageal manometry. During EGD, the doctor can detect typical signs of achalasia, such as the accumulation of food in the esophagus and insufficient opening of the cardia. Esophageal manometry allows for the assessment of pressure in different segments of the esophagus and the detection of abnormalities in contractile function.

Additional diagnostic methods may include radiographic examination of the esophagus after the ingestion of contrast fluid during swallowing. A combined approach to diagnosis allows for accurate diagnosis of achalasia, identification of its form, and determination of a treatment plan based on the individual needs of the patient.

  • Esophagogastroduodenoscopy (EGDS): this procedural method allows the doctor to visually assess the condition of the esophagus and stomach and to detect typical signs of achalasia, such as food retention in the esophagus and dysfunction of the cardia.
  • Esophageal manometry: this functional test measures pressure in various sections of the esophagus and allows for the assessment of contraction function, which helps confirm the diagnosis of achalasia.
  • Radiocontrast examination: the patient is asked to ingest a contrast substance while swallowing, after which an X-ray examination of the esophagus is performed to identify abnormalities in its movement and patency.
  • Clinical symptoms: characteristic patient complaints, such as difficulty swallowing, the sensation of food getting stuck, bitter regurgitation, and others, are also an important element in the process of diagnosing achalasia.
  • Consultation with a specialist: an important part of diagnosing achalasia is consulting an experienced gastroenterologist or surgeon for a detailed examination and developing an optimal treatment plan.

Effective methods for treating Achalasia

The treatment of achalasia may include conservative methods such as the use of medication, physiotherapy, and diet, as well as invasive procedures including surgical intervention. The use of nitrates, calcium antagonists, or botulinum toxin injections in the cardia area may help improve symptoms in some patients. However, in the case of definitive failure of diet and medication therapy, surgical methods may be required.

Surgical treatment of achalasia, such as esophageal myotomy, can be an effective method for improving symptoms in patients who do not respond to conservative therapy. In esophageal myotomy, the surgeon removes a portion of the muscle fibers of the cardia, which allows for improved passage and function of the esophagus. The decision on the choice of treatment method should be made individually, based on the clinical picture, the patient’s condition, and the recommendations of the doctors.

  • Medication therapy: Includes the use of pressure-reducing medications in the esophagus, such as nitrates and calcium antagonists, as well as injections of botulinum toxin to reduce the contractility of the esophageal muscles.
  • Diet: Special attention is given to consuming foods that facilitate easy passage through the esophagus and do not cause obstruction in the cardia.
  • Physical therapy: Includes exercises aimed at strengthening the esophageal muscles and improving their coordination, which can enhance esophageal patency.
  • Surgical intervention: Esophageal myotomy is a surgical procedure aimed at reducing the contractility of the cardia muscles to improve esophageal patency.
  • Palliative therapy: Includes methods to relieve symptoms without addressing the underlying cause, along with supportive treatment as necessary to improve the patient’s quality of life.

Methods for preventing Achalasia

As of today, there are no specific methods to prevent achalasia, since the exact causes of the disease have not been fully clarified. However, regular medical check-ups and screening procedures to identify the initial symptoms of achalasia can help in early detection and timely initiation of treatment. Maintaining overall esophageal health and carefully following doctors’ recommendations on diet and eating habits can also contribute to the prevention or reduction of the risk of developing this disease.

It is important to consider factors that may worsen the symptoms of achalasia, such as stress, insufficient chewing of food, obesity, and alcohol consumption. Patients with a hereditary predisposition, as well as those experiencing persistent difficulty swallowing or discomfort in the chest area, are advised to consult a doctor for preventive advice and further recommendations on maintaining digestive health.

  • Regular medical examinations: Conducting regular check-ups with a doctor can help detect early symptoms of achalasia and start treatment at early stages.
  • Following doctor’s recommendations: Maintaining esophageal health and adhering to dietary and eating recommendations can reduce the risk of the disease.
  • Avoiding risk factors: Stress, inadequate chewing of food, obesity, and alcohol consumption can worsen the symptoms of achalasia, so it is recommended to avoid these factors.
  • Maintaining a healthy lifestyle: Leading an active lifestyle, engaging in moderate exercise, eating a healthy diet, and avoiding harmful habits can contribute to the overall health of the digestive system.
  • Genetic counseling: Individuals with a hereditary burden or a family history of the disease may benefit from genetic counseling and receive recommendations for the prevention of achalasia.

Amazing aspects of Achalasia

Achalasia is a rare chronic disease of the digestive system, characterized by a disruption of esophageal peristalsis and insufficient opening of the cardia. Interestingly, this condition can manifest in various ways in different patients, making its diagnosis and treatment a challenge for doctors and specialists in the field of gastroenterology. Moreover, the onset of achalasia may be associated with both genetic factors and the environment, and research on this topic continues to clarify the more detailed causes of the disease.

The illness requires an individualized approach to treatment, and the results of various methods, ranging from conservative to surgical, can significantly differ among patients. This dynamic condition of the esophagus can lead to a variety of complications, such as food aspiration or esophagitis. Nevertheless, thanks to modern diagnostic methods and treatment options, progress is being made in managing this disease, opening new prospects for patients with achalasia.

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