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: add2370, 45-54 Female (Patient) Published: December 29

I had initial symptoms of achalasia at age 17 to 18, in 1987-88. It was labeled as many different things, but never had an appropriate diagnosis until other symptoms began to appear fifteen to twenty years later. These symptoms led me to a 23-hour observation that turned into 7 days. Finally I was diagnosed with achalasia at age 34. Mine was far gone enough to go straight to the myotomy/fundoplication surgical procedure. Following this surgery, I was able to lay down and sleep flat for the first time in nearly 20 years. Now, 11 years later, I am seeing a recurrence of symptoms, so I now need to go for a dilation. To anyone needing the surgery, I had a great experience with mine. I was told it may not be permanent and may see symptom recurrence after ten to twelve years, so it's right on track. I was on soft foods/ Nissan diet for a couple of weeks and then I went for my first steak in almost two decades. I was able to eat it and enjoy it. I too found that dietary changes often helped but only sometimes. Often icy cold water helps but not always. Some days, the throwing up helps more than others. But it is the nature of this illness.

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Comment from: BTL, 45-54 Male (Patient) Published: January 20

I began developing symptoms of achalasia over about an 18 month period. Mine became so bad that I could barely consume clear liquids standing up. I lost 40 pounds and would wake almost every night choking on food, liquid or just saliva. It took me a couple of months to get the Heller myotomy with Dor fundoplication. Since the operation, a little over two years ago, I can eat almost normally and can sleep lying down without problem. I still need to watch what I eat, eat slow, drink lots of liquids with my meals, and occasionally struggle to get food down when I fail to do what I just described. I can eat pretty much everything if I just take my time, chew it well and drink liquids with it. All in all, it gave me my life back. Any side effects, like mild nausea on occasion, are nothing; they can't be easily handled. You are never cured of this, but you can certainly control it and live a pretty normal life. Don't be afraid to have the surgery, it is short, easy and quick recovery. Don't put off getting the surgery, you will only kick yourself later if you wait.

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