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Achalasia

Overview

Achalasia is a disorder of the esophagus. It is characterized by reduced ability to swallow food down the esophagus and the inability of the lower esophageal sphincter to relax in response to swallowing.

This condition involves the loss of the wave-like contraction of smooth muscles that forces food through the digestive tract(peristalsis). Achalasia also includes spasms of the valve (sphincter) from the esophagus to the stomach that does not relax. There is also a lack of nervous stimulation of the esophagus.


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Causes

The main causes of the disorder include damage to the nerves of the esophagus, parasitic infection and even hereditary factors. Achalasia may occur at any age but increases with frequency with advancing age.


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Signs & Symptoms

Difficulty in swallowing liquids and solids is the main symptom of Achalasia. Regurgitation of food, pain in the chest that increases after eating are also seen. This pain may radiate to the back, neck, and arms. There is substantial weight loss, vomiting of blood, heartburn, drooling and cough. Some complications of the disorder may involve tearing (perforation) of the esophagus or regurgitation of acid or food from the stomach into the esophagus (reflux).

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Prevention

Many of the causes are not preventable. However, treatment of the disorder may help to prevent complications.


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Treatments
Medications and Surgery Modern Medicine

The approach to treatment is to reduce the pressure at the lower esophageal sphincter. This is done by manipulating the lower esophagus sphincter by special instruments. Medications such as long-acting nitrates or calcium channel blockers can also be used to lower the pressure at the lower esophagus sphincter. Sometimes, botulinum toxin is injected to relax the sphincter. Surgery to decrease the pressure in the lower sphincter (called an esophagomyotomy) may be indicated if other interventions fail.

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