Synonyms
Esophageal spasm, cardiac spasm, cardiac spasm, narrowing of the esophagus English:achalasia
Definition Achalasia
Achalasia is a rare disease which is based on a neuromuscular dysfunction (i.e. a disturbance in the interaction of muscles and nerves) of the oesophagus. The main symptom is the lack of relaxation of the lower oesophageal sphincter (lower esophageal sphincter), so that the food ingested is not transported properly into the stomach during swallowing. The lower esophageal sphincter normally ensures that the crushed food components are transported into the stomach.
This requires a slackening of the sphincter muscle. By tensing the muscles, it acts as a valve mechanism to prevent acid gastric fluid from entering the oesophagus (heartburn/reflux disease). – Throat
- Esophagus/Oesophagus
- Gastric entrance at diaphragmatic level (diaphragm)
- Stomach (Gaster)
Another characteristic of achalasia is a general lack of muscle movement (peristalsis) of the esophagus during the act of swallowing. The reason for this disease is the loss of the esophageal nerve plexus (loss of nerve tissue of unclear cause = loss/disturbance of the plexus myentericus Auerbach), which regulates the function of the esophageal muscles and is therefore responsible for the harmonious interaction of important muscle groups during swallowing.
Epidemiology
Achalasia is a rare disease (1 : 100. 000 /year) and usually begins between the ages of 25 and 60. 5% of patients are children. Men and women are equally affected.
Causes
Achalasia can be divided into two forms: Primary Achalasia:This is the most common form of the disease. The cause for the development of achalasia is unknown (ideopathic). Viral and autoimmune causes of the disease are suspected.
Secondary Achalasia:Secondary means that an achalasia develops as a consequence of another primary disease. In rare cases, a tumour of the oesophagus can destroy the plexus myentericus (nerve plexus of the oesophagus) and thereby cause achalasia. Even more rarely, Chagas’ disease, which occurs mainly in South Africa, can be responsible for achalasia. The parasitic pathogen Trypanosoma cruzi attacks the lower part of the oesophagus. Here too, however, it is characterized by the destruction (degeneration) of the nerve cells of the plexus myentericus.
Symptoms of achalasia
The signs (symptoms) of achalasia develop insidiously and progress steadily with increasing destruction of the nerve plexus. The dominant symptom is difficulty swallowing (dysphagia). The dysphagia manifests itself with both solid and liquid food.
In some cases it is even more pronounced when drinking (so-called paradoxical dysphagia). It comes to regurgitation of food, up to vomiting, because the swallowed food accumulates in the esophagus and is not transported further into the stomach. Characteristically, the patients do not complain of an acidic taste in the mouth, as in reflux disease (heartburn), because the food has not yet come into contact with the stomach acid.
There may also be pain, a feeling of fullness and a feeling of pressure behind the breastbone (retrosternal pain). This pain can be misinterpreted as heart pain. As the disease progresses, patients complain of progressive weight loss, and malnutrition symptoms can occur, especially in children. Achalasia patients often make use of helpful manoeuvres to support the swallowing act and the transport of food, such as stretching the neck and back when swallowing.
