Achalasia - Describe Your Experience

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What is achalasia?

Achalasia is a rare disease of the muscle of the esophagus (swallowing tube). The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, people with achalasia have difficulty swallowing food. In addition to the failure to relax, achalasia is associated with abnormalities of esophageal peristalsis (usually complete absence of peristalsis), the coordinated muscular activity of the body of the esophagus (which comprises 90% of the esophagus) that transports food from the throat to the stomach.

How does the normal esophagus function?

The esophagus has three functional parts. The uppermost part is the upper esophageal sphincter, a specialized ring of muscle that forms the upper end of the tubular esophagus and separates the esophagus from the throat. The upper sphincter remains closed most of the time to prevent food in the main part of the esophagus from backing up into the throat. The main part of the esophagus is referred to as the body of the esophagus, a long, muscular tube approximately 20 cm (8 in) in length. The third functional part of the esophagus is the lower esophageal sphincter, a ring of specialized esophageal muscle at the junction of the esophagus with the stomach. Like the upper sphincter, the lower sphincter remains closed most of the time to prevent food and acid from backing up into the body of the esophagus from the stomach.

The upper sphincter relaxes with swallowing to allow food and saliva to pass from the throat into the esophageal body. The muscle in the upper esophagus just below the upper sphincter then contracts, squeezing food and saliva further down into the esophageal body. The ring-like contraction of the muscle progresses down the body of the esophagus, propelling the food and saliva towards the stomach. (The progression of the muscular contraction through the esophageal body is referred to as a peristaltic wave.). By the time the peristaltic wave reaches the lower sphincter, the sphincter has opened, and the food passes into the stomach.

How is esophageal function abnormal in achalasia?

In achalasia there is an inability of the lower sphincter to relax and open to let food pass into the stomach. In at least half of the patients, the lower sphincter resting pressure (the pressure in the lower sphincter when the patient is not swallowing) also is abnormally high. In addition to the abnormalities of the lower sphincter, the muscle of the lower half to two-thirds of the body of the esophagus does not contract normally, that is, peristaltic waves do not occur, and, therefore, food and saliva are not propelled down the esophagus and into the stomach. A few patients with achalasia have high-pressure waves in the lower esophageal body following swallows, but these high-pressure waves are not effective in pushing food into the stomach. These patients are referred to as having "vigorous" achalasia. These abnormalities of the lower sphincter and esophageal body are responsible for food sticking in the esophagus.

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See what others are saying

Comment from: Liz, 25-34 Female (Patient) Published: October 21

I have been dealing with achalasia for about 3 years now. It started very mild, and I noticed it when I was out eating a big burger with a beer (I know now why it triggered a spasm) but over the years it progressed to almost every time I eat. Sometimes I can't even get water down. At first I thought maybe it was some type of eating anxiety but it got to the point of waking myself up regurgitating so I went to the doctor. I had already self-diagnosed myself but hospitals always have their procedural way of doing things. After lots of testing they diagnosed me with achalasia. I got a Botox injection which helped for almost a month but the achalasia creeped back in. I am scheduled to get a Heller myotomy on November 12th and I am nervous but so excited. Thank you everyone on this site for sharing your experiences! It has helped me cope with the frustration of this issue and help me know that I'm not alone in my struggles. Wishing you all the best!

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Comment from: JMB, 35-44 Female (Patient) Published: November 04

I was diagnosed with achalasia soon after the birth of my son, 12 years ago. I was showing symptoms as long as 15 years ago. I had two series of Botox injections that failed. I had a Heller myotomy that failed as well. Currently I take nifedipine to help me eat and drink. I developed aspiration pneumonia in 2009 but wasn't diagnosed until 2010. Despite many efforts to cure my incessant cough, I kept being handed Z-Pak and allergy pills by the doctors. A visit to the emergency room one morning finally led to the discovery of pneumonia. I have good days and bad days. I have severe body aches at times, stomach pain, joint pain, and there is never a trigger for any of it. Stress control is mandatory with this disease; if that's a thing. Esophageal spasms occur every single day. Sometimes hundreds a day, sometimes only 10 or so; that's another thing, no two days are the same. If I could eat eggs today, there's no guarantee I could eat them tomorrow. Literally the only peace I get from this disease is when I sleep. The hardest part of this disease, is watching my family watch me. The pain and worry in their faces shatters me. Being overweight makes this disease invisible to most people. They look at me and see a robust woman. But my body is stuck in this weird starvation mode and holds on to everything I eat. It's hard to describe to someone what it feels like to not be able to swallow even water sometimes. No one gets it. They can't unless they're going through it too. So to the next sufferer that reads this, good luck. I hope you have a family like mine that supports you.

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