Symptoms of Achalasia : Diagnostic Procedures

Achalasia: How to Recognize and Diagnose This Esophageal Disorder

Achalasia is one of the rare and chronic disorders of the oesophagus, a tube that conveys food from the mouth to the stomach. This disorder affects the ability of the oesophagus to move the food towards the stomach and causes trouble swallowing, regurgitation of food, and sometimes chest pain.

This can significantly impact the quality of life, hence making an early diagnosis with proper management very essential. In this blog, we will look at the symptoms and diagnosis of achalasia—what one must truly know about this oesophagal disorder.

What is Achalasia?

Achalasia is a condition whereby the LES fails to relax, and there is a loss of peristalsis in the oesophagal body. The LES is normally a ring of muscle that exists at the junction of the oesophagus and stomach and relaxes to permit the passage of food into the stomach. In achalasia, this muscle remains abnormally contracted, and food accumulates in the oesophagus, leading to various symptoms.

Symptoms of Achalasia

The symptoms of achalasia develop insidiously and progress over a period. They may vary in severity and include the following, amongst others:-

Difficulty Swallowing (Dysphagia)
 

The most common and frequently the first symptom of achalasia is dysphagia. Patients often experience a predominance of difficulty in swallowing during the intake of solid foods and liquids. This symptom can be either intermittent or progressive, getting worse as the condition advances. Some will describe a sensation of food getting stuck in their chest or throat.

Regurgitation of Undigested Food

Another hallmark symptom of achalasia is regurgitation. This refers to the passage of undigested oesophagal contents up into the mouth or throat following an attempt at swallowing. In contrast to vomiting, no nausea precedes regurgitation. It can be very uncomfortable, often leading to choking or aspiration.

Chest pain or discomfort, which is often described as a pressure or tightness behind the breastbone, may also occur. Since it resembles cardiac conditions, differential diagnosis might be very necessary. In achalasia, chest pain is generally caused by the distension of the esophagus by retained food and may be precipitated by eating.

Weight Loss

Weight loss unintentionally is a very common presenting symptom among all individuals affected by achalasia. The difficulty in swallowing and regurgitation make it difficult to take adequate amounts of food; this can lead to malnourishment, which eventually results in weight loss.

Heartburn

Some patients suffering from achalasia experience heartburn or, rather, symptoms similar to acid reflux. This has been attributed to the fermentation of retained food in the esophagus, which eventually produces acids irritating to the lining of the esophagus.

Nocturnal Coughing and Aspiration

nocturnal symptoms, coughing with aspiration, happen mostly in the supine position in achalasia. Swallowed regurgitated food could pass into the airway during sleep, result in coughing fits, and lead to an increased incidence of aspiration pneumonia.

The feeling of a Lump in the throat

The patients may have a sensation of a lump in the throat, which is called a Globus sensation. It may be uncomfortable and continuous in nature and thus contributes to the difficulty in swallowing.

Diagnosis of Achalasia

The diagnosis is based upon a combination of clinical evaluation, radiologic studies, and specialized tests studying the problems of the oesophagus and LES. Following are the diagnostic methods employed for the same:

History and Physical Examination

The diagnostic process begins with an appropriate history being taken and a physical examination. The doctor will ask about the symptoms, duration, and factors that exacerbate or relieve them from the patient. After taking a detailed history, achalasia is differentiated from other diseases with similar symptoms, such as gastroesophageal reflux disease or oesophagal cancer.

Barium Swallow (Esophagram)

A barium swallow is a type of X-ray study that generates finely detailed images of the inside of the oesophagus. This examination involves giving the patient a solution to drink containing barium, which greases the oesophagus and shows on X-rays. The characteristic findings of achalasia, including dilation of the oesophagus and narrowing of the LES, usually show up in the oesophagus. This is commonly described as the appearance of a "bird's beak."

Esophageal Manometry

Esophageal manometry is regarded as the gold standard test in the diagnosis of achalasia. These test measurements result in pressure and contraction of muscles in the oesophagus. In this procedure, a thin, flexible tube with pressure sensors reaches the oesophagus through the nose. The patient is asked to swallow small amounts of water during the test, and sensors record the changes in muscle activity and pressure.

In achalasia, manometry classically shows:

Absent Peristalsis: Due to absence, or considerate reduction in the amplitude of, contractions of smooth muscles which propel food down the oesophagus

High LES Pressure: High pressure at the lower oesophagal sphincter; it does not relax appropriately during swallowing.

Endoscopy

An upper endoscopy, or esophagogastroduodenoscopy, EGD, is a test that visualizes directly the contents of the esophagus, the LES, and the stomach. During this test, there is the inclusion of a flexible tube with a light and a camera at the very end that goes through the mouth into the oesophagus. Endoscopy rules out other conditions that can imitate achalasia, such as oesophagal strictures, tumours, inflammation, or any abnormal narrowing in the oesophagus.

Esophageal pH Monitoring:

Oesophageal pH monitoring quantifies acid reflux to the oesophagus. While this study is not usually indicated to establish the diagnosis of achalasia, it can be useful in differentiating achalasia from GERD in patients with overlapping symptoms.

Timed Barium Esophagogram

An esophageal timed barium esophagogram is a variant of the conventional test; X-ray images are taken at set, timed intervals after the ingestion of barium solution. It assesses the rate of emptying and gives an approximate value for the severity of achalasia.

High-Resolution Manometry

High-Resolution Manometry: HRM is a relatively advanced form of oesophagal manometry, which more precisely defines the assessment of motor activity of the oesophagus. In HRM, a catheter with closely spaced pressure sensors is used to generate pressure activity in the oesophagus. This clearly enhances the accuracy of diagnosing achalasia and characterizing its subtypes.
 

Summary:

Achalasia is a difficult oesophagal disorder that mayλο have a great influence on a patient's quality of life. The situation calls for the recognition of symptoms and getting an accurate diagnosis for its effective management. Difficulty in swallowing, regurgitation of undigested food, chest pain, weight loss, and nocturnal symptoms are the referring features of achalasia.

Diagnostic tests, like barium swallow, oesophagal manometry, endoscopy, and oesophagal pH monitoring, have some critical roles in the confirmation of diagnosis and guiding treatment.

If one has been experiencing the symptoms of achalasia for quite a longer period, it is best to seek immediate medical attention. Early diagnosis and proper management may give relief to the symptoms, improve the quality of life, and minimize potential complications that may arise from having the disease. These are the options available in the management of cases of achalasia and the alleviation of the very few but greatly affected people with such a disorder. Treatment includes medications, endoscopic procedures, and surgical interventions that will address the said condition.