Achalasia - Causes

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What causes achalasia?

The cause of achalasia is unknown. Theories on causation invoke infection, heredity or an abnormality of the immune system that causes the body itself to damage the esophagus (autoimmune disease).

The esophagus contains both muscles and nerves. The nerves coordinate the relaxation and opening of the sphincters as well as the peristaltic waves in the body of the esophagus. Achalasia has effects on both the muscles and nerves of the esophagus; however, the effects on the nerves are believed to be the most important. Early in achalasia, inflammation can be seen (when examined under the microscope) in the muscle of the lower esophagus, especially around the nerves. As the disease progresses, the nerves begin to degenerate and ultimately disappear, particularly the nerves that cause the lower esophageal sphincter to relax. Still later in the progression of the disease, muscle cells begin to degenerate, possibly because of the damage to the nerves. The result of these changes is a lower sphincter that cannot relax and muscle in the lower esophageal body that cannot support peristaltic waves. With time, the body of the esophagus stretches and becomes enlarged (dilated).

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See what others are saying

Comment from: diane, 65-74 Female (Patient) Published: November 25

I first experienced the difficulty in swallowing about two years ago. It happens infrequently but is of concern. I suspect the achalasia is related to some medications I take, specifically niacin. I wonder if anyone else has experienced a relationship with achalasia and medications. When I stop taking medications for a while, it doesn't seem to happen. It seems related to eating meat and usually occurs at dinner time.

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Comment from: attaboy, 35-44 Male (Patient) Published: September 02

I was 23 when I first discovered I had achalasia. I don't remember any symptoms before it happened, though I'm sure there were some. I was out in the field, trying to eat a sandwich one day and it just wouldn't go down. I tried water, and it wouldn't either. After 2 days of not eating or drinking I went to the hospital. They performed a stretch on my esophagus and it lasted 2 or 3 days. I went back about a month later and had the same results. Finally I had a laparoscopic Heller myotomy on my 24th birthday. Between the time of my first symptoms and surgery I lost almost 50 lb. I dropped from 170 to almost 120. That's been almost 12 years now. I can eat about anything I wish, but I have to have lots of water to wash it down. I also take Prilosec almost every day to help deal with occasional heartburn. I avoid some foods that I know will set it off, but I can sometimes sneeze or cough too hard and get heartburn as well.

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