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Answer to your Health Question

Question (08/30/2012):

Title: How a person develops Achalasia? .

I had an EGD done recently and was told that I had achalasia, and a hietal hernia, chronic gastritis, and H. Pylori.

The reason for the test was my symptoms of nausea, vomiting, and my stomach contents coming up when i bent over, sitting up on the bedside in the morning upon waking, even when tying my shoe.

The Dr. said that it was a combination of my hietal hernia and achalasia.

Could you please explain what achalasia is how a person develops it and the treatment?

My Dr told me there was a surgical procedure that could fix the hietal hernia and the achalasia both but it was not without risks.


Thank you for your question.

Achalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.

A muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.

The cause of most cases of achalasia is unknown.

Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as gastroesophageal reflux disease (GERD), hiatus hernia, and even psychosomatic disorders.

The approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:

-Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.

- Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincter

-Surgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincter

- Widening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)

Sublingual nifedipine significantly improves outcomes in 75% of people with mild or moderate disease. Surgical myotomy provides greater benefit than either botulinum toxin or dilation in those who fail medical management.

Achalasia is a rare disorder.

Achalasia can be difficult to diagnose because it has symptoms similar to other digestive disorders.

The latest technology to diagnose Achalasia include:

-Esophageal manometry. Using a catheter inserted down your esophagus, muscle contractions in your esophagus are measured when you swallow water. High-resolution manometry, used at Mayo Clinic, can assess the severity of your achalasia and guide treatment decisions.

Other useful tests include:

-Esophagram (barium swallow). An X-ray visualizes movement of liquids through the esophagus when you swallow.

-Endoscopy. A flexible, narrow tube (endoscope) with a camera is used to view the inside of the esophagus and stomach.

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