Achalasia is a rare disease that makes it hard to swallow foods and liquids. In achalasia, there is a problem with the tube that carries food from the mouth to the stomach (esophagus). The muscles that make the esophagus contract and push food down to the stomach don’t work well. The muscle contractions get weak.
The LES (lower esophageal sphincter) also doesn’t work well. The LES is the muscle at the bottom of the esophagus, where it joins the stomach. With achalasia, the LES gets narrow and tight. Food does not pass into the stomach as it should. Over time, food and liquid can collect in the esophagus. This disorder happens more often in adults. It is rare in children.
Achalasia affects males and females equally. In some cases, there may be a family history of achalasia.Achalasia happens because of problems with the nerve cells in the esophageal muscles. Experts don’t know what causes these abnormalities. In children, achalasia is often linked with other conditions. These include adrenal glucocorticoid deficiency, Allgrove syndrome, and Down syndrome.
Symptoms often start slowly and get worse over time. They may look like symptoms of other disorders. Make sure your child sees his or her healthcare provider for a diagnosis. The following are common symptoms of achalasia:
- Vomiting undigested food
- Having trouble swallowing
- Losing weight
- Not gaining weight
- Pain or a burning feeling in the chest
- Coughing a lot after eating
- Bad breath
Your child's healthcare provider may suspect achalasia if symptoms have lasted for a few weeks and are getting worse. To make a diagnosis, the provider will look into the esophagus and do special tests. These tests take pictures and measure pressures inside the esophagus while a child is swallowing. These tests include:
- X-ray. A chest X-ray may show widening and fluid in the esophagus.
- Endoscopy. A flexible tube (endoscope) is passed into the esophagus.
- Barium swallow (esophogram). Pictures may be taken while the child swallows a thick liquid that shows up on X-rays.
- Manometry. Pressures may be measured inside the esophagus as the child swallows sips of water.
Achalasia often gets worse if it is not treated. Medicines are not very effective. Surgery is almost always recommended. Types of surgery include:
- Balloon dilation. A special type of balloon is passed through an endoscope into the esophagus. The balloon is inflated. This stretches the tight LES muscles where the esophagus narrows as it meets the stomach. This surgery does not work as well in children as it does in adults. It often does not give long-term relief.
- Esophagomyotomy. This surgery is the best treatment for children. It may be done using a laparoscope (laparoscopic Heller myotomy). For laparoscopy, the healthcare provider makes several small cuts (incisions) to put instruments into the chest (or elsewhere) for surgery.Or it may be done as an open (traditional) surgery. The surgeon cuts the LES muscles in the tight area at the end of the esophagus. This lets food pass through to the stomach. In most cases, this eases symptoms. It is a safe procedure with long-lasting results for children.
- Fundoplication. This surgery is often done together with an esophagomyotomy. This is an anti-reflux surgery. A part of the upper stomach is wrapped around the lower esophagus. This stops acid reflux from the stomach from flowing back into the esophagus after the LES has been cut.
- Achalasia is a rare disease that makes it hard to swallow foods and liquids.
- This disorder happens more often in adults. It is rare in children.
- The muscles of the food pipe (esophagus) get weak and don’t work well.
- Food and liquids don’t pass into the stomach. They can collect in the esophagus.
- Symptoms include vomiting after eating, and weight loss.
- Once a diagnosis is made, surgery is often very effective.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure
May 10, 2018
Surgical myotomy for achalasia. UpToDate., Overview of the Treatment of Achalasia. UpToDate., Achalasia: Pathogenesis, Manifestations, and Clinical Diagnosis. UpToDate., Vaezi MF. The American College of Gastroenterology Clinical Guideline: Diagnosis and Management of Achalasia. American Journal of Gastroenterology. 2013;108(8):s1238-49.
Adler, Liora C, MD,Hanrahan, John, MD