welcome to disease section for achalasia 

Difference between a normal esophagus and Esophageal achalasia
Difference between a normal esophagus and Esophageal achalasia

The esophagus is a muscular tube that carries food and liquids from the mouth to the stomach. There are various diseases associated with it such as esophagitis, GERD, achalasia, etc. Esophageal achalasia or achalasia is a condition when the lower esophageal sphincter (valve) does not relax. The LES fails to open up during swallowing and results in food back up. Achalasia can be related to damaging of nerves in the esophagus but the actual cause of this condition is unknown.

Esophagus anatomy and helicobacter pylori
Esophagus anatomy and helicobacter pylori

H. pylori are pathogens in the stomach which provoke inflammatory responses, such as “chronic gastritis,” and sometimes, lead to peptic ulceration or gastric cancer. Chronic gastritis can decrease the production of gastric acid and possibly result in Barrett esophagus or gastroesophageal reflux. Gastroesophageal reflux (GERD) is a digestive disorder that affects the lower esophageal sphincter (LES). It is found that due to similar symptoms, achalasia is often misdiagnosed as GERD.

Esophageal sphincters image
Esophageal sphincters image

The esophagus has two muscular rings or sphincters in its wall, one at the top and the other at the bottom. Below the junction of the throat and the esophagus is a band of muscle called the upper esophageal sphincter (UES) and slightly above the junction of the esophagus and the stomach is the lower esophageal sphincter (LES). When the upper esophageal sphincter opens, the food slides down the esophagus and pass the lower esophageal sphincter to enter into the stomach. Achalasia results when the LES fails to open up during swallowing. 

Endoscopic monitoring of esophagus and stomach
Endoscopic monitoring of esophagus and stomach

Upper endoscopy procedure is used to diagnose the esophagus and the stomach. A thin flexible tube or a scope is inserted through the throat with a light and camera at its tip to look inside of the upper digestive system. The tube records the muscle activity and can detect any abnormality. An endoscopic procedure helps to determine partial blockage of the esophagus. Endoscopy is also used to collect a sample of tissue (for biopsy) to be tested for complications of reflux such as Barrett's esophagus.

Expansion of the esophagus
Expansion of the esophagus

Achalasia is referred to as an esophageal motility disorder. It is characterized by the absence of muscle contractions (wave-like) and the failure of lower esophageal sphincter to relax. If a person is suffering from achalasia, the lower esophageal sphincter fails to open up during swallowing and leads to a backup of food within the esophagus. Dilation or stretching or expansion of esophagus provides relief from discomfort and difficulty in swallowing.

Diagnosing Achalasia
Diagnosing Achalasia

The given picture indicates that achalasia leads to the dilation or widening of the esophagus. This is because the lower esophageal sphincter does not work properly and results in the formation of “bird beak” deformity. The lower esophageal sphincter tightens and does not allow the food to move down into the stomach which results in food backup. Also, abnormal closing of LES results in acidic reflux.

Achalasia EMS
Achalasia EMS

Esophageal motility study (EMS) for achalasia is used to measure the function of lower esophageal region and the muscles of the esophagus. This test helps to diagnose whether or not the esophagus is able to move food to your stomach normally. A thin, flexible tube is made to pass through the nostril, down through the esophagus and into the stomach. The tube senses the esophageal motion and pressure during swallowing of food which is reported on a graph.

Radiography for Achalasia
Radiography for Achalasia

The given chest X-ray image of a patient suffering from achalasia shows an air bubble below the left hemi-diaphragm (one half of the diaphragm) in the gastric region. In general, bubbles are not commonly observed in achalasia patients. To confirm the diagnosis, upper gastrointestinal endoscopy, barium-swallow X-ray, or pneumatic balloon dilatation of the lower esophageal sphincter is recommended.

Barium-Swallow: Diagnosis of achalasia
Barium-Swallow: Diagnosis of achalasia

Barium-swallow is a common test to diagnose achalasia. A white liquid containing the chemical, barium, is taken and swallowed and an X-ray scan is done. Barium coats the inside of the esophagus and the stomach and helps to provide a clear picture during the X-ray. Barium swallow test is done both, before and after an esophageal surgery. In the X-ray, the lower part of the esophagus is observed to be narrowed whereas the upper part seems to be stretched. Surgery for achalasia allows easy swallowing. 

Gastroesophageal reflux disease
Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a condition in which the food backs up after swallowing, thereby resulting in acidic reflux. Food back-up or acid reflux happens when the lower esophageal sphincter (LES) does not tighten or close properly. LES is a circular ring-like band of muscle at the end of the esophagus, connected to the stomach. In most cases, achalasia is misunderstood as GERD due to similar symptoms.