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: carolbva, 55-64 Female (Patient) Published: October 08

I began having issues swallowing and gradually began projectile vomiting. I was diagnosed with a hiatal hernia and I had surgery. Swallowing issues gradually returned and several dilutions were done. Problems increased. In 2004 I was diagnosed with achalasia. Tests revealed the original surgery was badly botched resulting in a large "pouch" on the side of my esophagus and achalasia. Immediate surgery was required to avoid a ruptured esophagus. A Heller myotomy among other things were performed, the hernia repaired, and a teflon mesh applied to the esophagus to ensure the pouch never returned. There was a 20% chance the achalasia would disappear. Unfortunately it has not. Prilosec OTC is the drug of choice and every few years I go in for a dilatation. I drink lots of water to encourage food to go down. I still can't eat steak but pork chops go down fine! The second surgery has caused severe scar tissue and nerve pain now because the nerves have finally begun growing back together. Even so, I encourage all of you to check out a top notch cardiothoracic surgeon to see if possibly surgery is an option.

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Comment from: lhuhn, 35-44 Female (Patient) Published: November 27

I have had the bouts for about 8 years now with food getting stuck, and then finally going down, or until I make myself throw up. I have had 6 children and had 2 dilatations done to my esophagus. The doctor just told me that I will have to deal with this forever because it is due to having kids and I have a hernia and no surgery can be done. Now I am wondering if I have achalasia and there is something that can be done. I am to the stage of choking on soft foods and sometimes a drink if I drink too quickly. When it is stuck I feel like I have to burp but that does not help. I think that is a mind thing because my body is trying to pass the food down to my stomach. It is very painful and I usually walk around and feel like I am going to lose my mind. The choking is to the point that it is hard for me to go out to eat with my family or eating within a group of people at work. I stress over it wondering if it will go down or will I have to run to the bathroom to expel the food. I am hoping to do a little more research and find the best solution for my issues. I did notice that my air intake must be connected in some way because when I did get the dilatation process done I noted that I could breathe better.

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