Achalasia: Understanding This Complex Esophageal Disorder

It is a disorder of the function of the esophagus in which peristalsis (normal movements of the esophagus) is practically non-existent, the lower esophageal sphincter does not relax and the passage of food from the esophagus to the stomach is seriously hampered.

Cause

The cause of achalasia is not known, it is idiopathic. Is a very rare disease in children.

At the end of the esophagus is the lower esophageal sphincter that remains closed while food is not being swallowed, thus preventing food and stomach acid from moving up through the esophagus. While swallowing, nerve signals tell the musculature of the esophagus It contracts to push food down the length of the esophagus and allow the lower esophageal sphincter to open.

In achalasia there is an alteration in the nerve and sphincter signals resulting in the muscular activity of the esophagus is not coordinated and that the LES cannot be fully opened. These motor alterations cause an accumulation of food that cannot pass into the stomach, which causes the lower part of the esophagus to dilate, causing the symptoms and complications of the disease to appear.

Symptoms

The most frequent symptoms It is the difficulty in swallowing food (dysphagia) and that of food from the stomach to the mouth. In some cases, retrosternal pain, weight loss, asthma or halitosis (bad breath) may appear.

How is one rare disease in children it is diagnosed late.

Diagnosis

The diagnosis is based on the symptoms reported by the patient and a series of scans that confirm the referred motor alterations.

These tests can include:

• Esophageal manometry: A tube is inserted through the mouth and down the esophagus that detects esophageal pressure and hypertonia (increased muscle tone) of the lower esophageal sphincter.
• Esophagram: X-rays of the esophagus after ingesting a contrast liquid that allows the outline of the esophagus to be drawn. Typically the esophagus appears dilated in its proximal part and narrow in its distal part.
• Gastroscopy- A fiberoptic tube is inserted into the esophagus to allow direct viewing. It is done mostly to rule out other causes of narrowing of the esophagus (such as a tumor).
• This test is done to rule out the presence of reflux.

Treatment

Treatment is aimed at reduce pressure in the lower esophagus.

Several treatments can be performed that the pediatric gastroenterologist must assess:

• Pharmacotherapy: Drugs that decrease the pressure of the lower esophageal sphincter are used. In general, it is indicated in elderly patients and / or with contraindications for treatment by dilations.
• Pneumatic (endoscopic) dilation: the treatment most used and of choice. It consists of introducing a tube to the end of the esophagus at the end of which is a balloon that is inflated to break the muscle fibers of the lower esophageal sphincter. It is an effective treatment in more than 70% of the cases. Possible complications include rupture and perforation of the esophagus and the appearance of reflux. Many patients require more than one dilation.
• Surgical treatmentThe most common technique is the Heller cardiomyotomy, which consists of a small incision to cut the fibers of the sphincter to help you relax. Because the sphincter is partially cut, some patients may later develop acid reflux. This technique can also be performed by laparoscopic surgery.
• Botulinum toxin injections into the sphincter: has a temporary effect. It is indicated in the elderly or patients who are not candidates for dilation or surgery.