Achalasia (synonyms: esophageal motility disorder; esophageal achalasia; cardiaspasm; cardia achalasia; ICD-10-GM K22.0: achalasia of the cardia) is a disorder belonging to the group of esophageal motility disorders. On the one hand, there is a relaxation disorder of the lower esophageal sphincter (UES; esophageal sphincter/gastric inlet), meaning that the lower esophageal muscle does not relax during the swallowing process, and on the other hand, the motility (mobility) of the middle and lower esophageal muscles is impaired. As a result, the transport of the food pulp through the esophagus (food pipe) is disturbed.
The following forms of achalasia are distinguished:
- Primary achalasia (idiopathic form/no identifiable cause) – neurodegenerative disease.
- Secondary achalasia (“pseudoachalasia”) – this form is based on another disease.
Achalasia progresses through the following stages:
- Stage I (hypermotile (hypermobile) form) – the resting pressure of the lower esophageal sphincter (UES) is increased; the esophageal muscles attempt to compensate for the increased pressure by increasing peristalsis
- Stage II (hypomotile form) – dilatation (expansion) of the esophagus; the esophageal muscles become more sluggish.
- Stage III (amotile (immobile) form) – esophageal musculature is flaccid; esophagus is significantly dilated
Sex ratio: males and females are equally affected.
Frequency peak: the disease occurs predominantly in middle age, that is, between the 3rd and 5th decade of life.There are also diseases in adolescence, childhood and neonates possible.
The incidence (frequency of new cases) of primary achalasia is about 1-3 cases per 100,000 inhabitants per year (in Germany).
Course and prognosis: The longer the achalasia persists, the more pronounced the dysphagia (difficulty swallowing) becomes. It is the leading symptom of the disease. The disease is progressive, i.e. the closure of the lower esophageal sphincter increases. The transport of food is limited. The affected person takes in less food due to the symptoms. The result is weight loss. If food remains in the esophagus, bronchial infections may occur. Ultimately, retention esophagitis (esophagitis caused by lack of exercise) may develop, which is a risk factor for esophageal cancer. In view of this, those affected should attend regular preventive check-ups.The disease cannot be cured, so therapy is symptom-based. The focus is on achieving adequate food intake.
