Esophageal achalasia is a rare disease of the esophagus and the difficulty in swallowing is the characteristic symptom. Professor Alessandro Repici, Head of Digestive Endoscopy at Humanitas and Professor at Humanitas University, spoke about the diagnosis and treatment of this disease in an interview with Corriere della Sera.

Achalasia is a rare disease, but in recent years the number of cases has increased. Numerous hypotheses have been made about the causes at its origin, but there is currently no certainty. “What is certain is that if you neglect it you are not only hurting, but increasing the risk of developing an esophageal tumor,” said Professor Repici.


What is esophageal achalasia?

In patients with esophageal achalasia there is an abnormal contraction of the terminal part of the esophageal muscle (which covers the entire esophagus), resulting in fatigue of the food ingested to reach the stomach. What is eaten accumulates in the final part of the esophagus until something else is swallowed that exerts pressure on the food “stuck” and pushes it towards the stomach.

“Over time, this condition causes the esophagus to dilate due to the accumulation of food, which also causes chronic inflammation,” Professor Repici explained.

The difficulty to swallow is the characteristic symptom, in addition other symptoms may include: acid regurgitation, chest pain, slimming and in severe cases, vomiting.


How is it diagnosed?

A gastroenterological examination is required for diagnosis. The specialist could use gastroscopy in the first instance, a useful test to confirm the suspicions and to rule out that the disturbances are caused by the presence of a mechanical obstacle, such as an esophageal tumor.

However, manometry allows achalasia to be diagnosed in a certain way: it is an examination that records the pressure activity of the esophagus.

It is also indicated to perform an esophageal radiography with contrast medium, which shows the level of expansion of the esophagus.


Available treatments

Drug therapy is not effective in patients with esophageal achalasia. The best option is based on cutting the muscle layer along the esophagus, an operation that in the past was performed only with laparoscopic surgery, while “for a few years it has become increasingly common to use a minimally invasive technique that leaves no scars, called POEM (transoral endoscopic myotomy), in which the incision of the muscle fibers of the esophagus is performed through a flexible endoscopy, similar to that used for gastroscopy,” explained Professor Repici.

Another endoscopic alternative is the dilation of the esophagus with a balloon, a technique that however presents a greater risk of recurrence. “This procedure consists in introducing an inflatable balloon through the mouth that is lowered down to the lower esophageal sphincter, and here it is inflated causing a traumatic rupture of the esophageal muscle,” concluded Professor Repici.