Achalasia — From Symptoms To Solution

Swallowing is an action we often take for granted, until it becomes a challenge. Achalasia, a rare yet serious disorder affecting oesophageal motility, interferes with this fundamental function and can make every meal a daunting task. From the initial signs of swallowing difficulties to the eventual relief provided by effective treatment, the journey can be lengthy and fraught with uncertainty. Thankfully, innovations like POEM (Peroral Endoscopic Myotomy) have rendered the treatment of achalasia safer and more efficient than ever before. This blog guides you through the entire journey of achalasia — from identifying the earliest symptoms to receiving a diagnosis and examining the most effective treatment options — enabling you to gain a deeper understanding of the condition and the path to recovery.

The early signs — When eating becomes a problem

Achalasia does not manifest with abrupt, severe symptoms. It typically begins gradually, presenting as occasional difficulty in swallowing or an unusual sensation of food feeling “stuck”. However, these minor irritations can develop into everyday challenges over time. It is thus essential to pay attention to these “minor” issues coming up every day or very frequently.

Frequent early indicators:

· Dysphagia: Difficulty swallowing solid foods, and eventually even liquids.

· Regurgitation: Food or saliva returning hours after consumption.

· Chest pain or discomfort: Often confused with heartburn or cardiac issues

· Unexplained weight loss: Resulting from decreased food intake and inadequate nutrition.

· Heartburn-like sensations: Although not due to acid reflux, the feeling can be similar.

These symptoms generally intensify as time progresses. Regrettably, many individuals are incorrectly diagnosed with GERD (gastroesophageal reflux disease) or anxiety-related eating disorders before the actual issue is identified.

Getting help — When to approach a doctor

If you frequently experience difficulty in swallowing, or you have begun avoiding meals, or find yourself waking up due to regurgitation, it is essential to seek medical help. While it may be tempting to self-diagnose or brush off symptoms as temporary, achalasia is a progressive condition that necessitates medical treatment. Your primary care physician may refer you to a gastroenterologist, a specialist equipped to diagnose and manage oesophageal and digestive disorders.

Getting the right diagnosis done

Diagnosing achalasia necessitates a series of specialized tests to evaluate the functioning of the oesophagus and its ability to empty correctly. These tests include –

· The Barium Swallow Test

This test will require you to consume barium in liquid form, after which a sequence of X-rays will be done to document its passage through your oesophagus. These X-rays will reveal if there is a constricted LES and an expanded oesophagus, often resembling a bird’s beak.

· Upper Endoscopy (EGD)

An endoscope, which is a slender flexible tube equipped with a camera, is introduced through the mouth to examine the lining of the oesophagus and stomach. This test will help detect strictures or inflammation that may imitate achalasia symptoms.

· Oesophageal Manometry

This test is considered the gold standard for diagnosing achalasia. In this test, a slender catheter gauges the pressure and muscle coordination in the oesophagus during swallowing. It verifies the absence of peristalsis (muscle movement) and the inability of the LES to relax.

Collectively, these tests not only validate the diagnosis, but also assist in identifying the type of achalasia (Type I, II, or III), which informs treatment strategies

Exploring treatment options

Achalasia currently has no definitive cure, but various treatment options exist to alleviate LES pressure and enhance swallowing capabilities. The selection of the most appropriate treatment is influenced by the severity of symptoms, the specific type of achalasia, the patient’s age, and their overall health status.

· Medication

Medications such as nitrates or calcium channel blockers can help lower LES pressure; however, they are seldom utilized as primary treatments due to their limited efficacy and potential side effects.

· Botox injections

These injections are administered through endoscopy into the LES to relax the muscle. These minimally invasive injections are best for patients who are not eligible for surgery. However, this treatment provides only temporary relief, anywhere between 3–6 months, after which a repeated treatment will be required, which again may result in scarring, or even decreased effectiveness with time.

· Pneumatic Dilation

This is a non-surgical approach where a balloon is inserted and inflated to expand the LES. This brings immediate outcomes, but there is always a risk of perforation, and multiple sessions may be required.

· Laparoscopic Heller Myotomy

This is a surgical procedure that involves cutting the LES muscle through small incisions in the abdomen. It is often paired with a fundoplication to minimize the risk of reflux. However, this invasive procedure requires a long recovery period.

· POEM (Peroral Endoscopic Myotomy)

This is a modern minimally invasive approach, a revolutionary procedure conducted endoscopically, eliminating the need for external incisions. During the POEM procedure, a submucosal tunnel is formed within the oesophageal wall, and the inner muscle fibres of the LES are severed. The tunnel is then closed, alleviating the obstruction while reducing trauma. This procedure has seen high success rates for all types of achalasia, and requires only a short 1–2 day short hospital stay, with a reduced recovery time required. With all these benefits, POEM is now acknowledged worldwide as one of the most effective treatments for achalasia.

Living with achalasia can significantly impact emotional well-being, as many individuals face anxiety related to eating in public, fear of choking, feelings of social isolation, and embarrassment prior to receiving a diagnosis or treatment. The path from experiencing symptoms to finding a solution may not be easy; however, with early detection, precise diagnosis, and the right treatment procedures, patients frequently see considerable improvements in both their symptoms and overall quality of life. Whether you are just starting to face difficulties with swallowing or are in search of a permanent solution, remember that you are not alone. Just get in touch with Mission Gastro Hospital, where expert gastroenterologists offer advanced, patient-focused care for achalasia, including minimally invasive treatments like POEM treatment in Ahmedabad. With the right guidance and support, you can overcome your symptoms and reclaim a healthier, more confident life — one step at a time.

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