achalasia

(ā″kă-lā′zh(ē)-ă)

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[2an- + chalasia]
Failure to relax; said of smooth muscles, such as those positioned between the lower esophagus and the stomach. It is a cause of dysphagia (difficulty swallowing).
SYN: SEE: achalasia of the cardia; SEE: cardiospasm

INCIDENCE
About 1.5 people out of every 100,000 are diagnosed with achalasia annually.

CAUSES
The cause of achalasia is unknown.

SYMPTOMS AND SIGNS
People with achalasia report gradual onset of increasing difficulty swallowing, both for solids and liquids.

DIAGNOSIS
Achalasia is typically indicated by an abnormal barium swallow test, in which barium accumulates in a dilated esophagus, which tapers to a narrow beak at the esophagogastric junction. The condition is confirmed by esophageal manometry.

TREATMENT
Medical treatments include oral nitrates and or nifedipine (a calcium channel blocker). Many patients find that these medications to be mildly effective but that the effectiveness of treatment wanes over time. Pneumatic dilation of the esophagus provides short-term relief for some patients. Surgical division of the esophageal musculature is the most effective treatment, although also the most invasive. It can be performed via an endoscope and has a successful outcome in nearly 90% of patients.

IMPACT ON HEALTH
Mild weight loss sometimes occurs. After 10 or 15 years, patients with achalasia have a statistically increased risk of developing esophageal cancers. This risk is relatively low, and gastroenterologists do not currently recommend regular surveillance for cancer in achalasia patients.

PATIENT CARE
Some patients with achalasia benefit from eating slowly, taking small bites, and avoiding swallowing large volumes of food or liquid. Patient education centers on adaptations the patient may make to avoid esophageal pain, regurgitation, and weight loss. Some patients are referred for surgical myotomy or esophageal dilation, but these procedures vary in their effectiveness.

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