A very dangerous complication of achalasia is the inhalation of food residues (aspiration). Patients are particularly at risk at night when the reflexes and thus the gag reflex are weakened. If the inhaled food (aspirate) reaches the lower airways, a life-threatening pneumonia (aspiration pneumonia) can occur.
The delayed passage of the food can lead to inflammatory processes in the mucous membrane of the oesophagus. In the worst case, such chronic damage to the mucous membrane can lead to esophageal cancer. Achalasia patients have a 15 times higher risk of developing esophageal cancer.
In the rarest case, the overfilling of the esophagus can lead to a tear (perforation) in the esophageal wall (esophageal tear) and the transfer of food components into the chest cavity. Such an event represents an absolute, life-threatening emergency. Apart from bleeding and injury to other organs during the rupture itself, a life-threatening inflammation of the mediastinum of the chest (mediastinitis) can also develop.
Technical examination procedures are necessary to ensure the diagnosis of achalasia:This examination is the method of choice in advanced stages of achalasia. A typical x-ray finding of achalasia in the upper part of the esophagus shows a strong accumulation of contrast medium in the esophagus, indicating an excessively dilated esophagus (megaesophagus), followed by a sudden narrowing of the esophagus just before the entrance to the stomach, caused by the lack of flaccidity of the lower esophageal sphincter. The descriptive term for this typical radiological achalasia phenomenon is the “champagne or wine glass” shape of the esophagus.
If a narrowing of the oesophagus was detected during the “pap smear” X-ray, an endoscopy should be performed to rule out other reasons for the narrowing. For example, an oesophageal tumour located at the level of the lower oesophageal sphincter (oesophageal sphincter muscle in front of the stomach) can mimic the image of an achalasia. In general, endoscopy (endoscopy) is part of routine diagnostics in cases of suspected achalasia.
This procedure is particularly suitable for the diagnosis of early-stage achalasia. A probe is inserted through the nose into the stomach and then slowly withdrawn towards the mouth. When the probe is pulled back, the pressure in the oesophagus is continuously measured at the end of the probe using a balloon.
A device draws a graph to illustrate the pressure conditions in the course of the oesophagus. This allows the diagnosis of severe dysfunctions of the lower esophageal sphincter (esophageal sphincter muscle). Achalasia is typically characterized by the lack of relaxation of the lower esophageal sphincter during the act of swallowing, as well as increased resting pressure of the esophagus in this area. Above the esophageal sphincter, the lack of muscular activity of the esophagus is evident.