WHAT IS IDIOPATHIC ACHALASIA OF THE OESOPHAGUS?
Idiopathic oesophageal achalasia is a primary oesophageal motor disorder characterised by loss of oesophageal peristalsis (the muscular contractions that ensure progression of food in the oesophagus) and insufficient lower oesophageal sphincter (LES) relaxation in response to swallowing.
It is a rare disease with annual incidence of approximately one per 100,000 and prevalence of one per 10,000. Oesophageal achalasia affects men and women equally; it can occur at any age, but it is generally diagnosed between ages 25 and 60.
It is mainly characterised by difficulty in swallowing solids and liquids, regurgitation of undigested food and retrosternal pain (in the thorax, behind the sternum). Weight loss (between 5 and 10 kg) can be observed in most, but not all, patients. Stomach burns occur in 27-42% of patients suffering from achalasia.
Some familial cases have been reported, but the rarity of these familial cases does not support the hypothesis of genetic factors playing a role.
HOW IS THIS PATHOLOGY DIAGNOSED?
Diagnosis is based on the patient’s medical history as well as his/her current health, on radiographic examination of the oesophagus (barium swallow test) and on an exam of oesophageal mobility (oesophageal manometry). Endoscopic exams are important for eliminating the possibility of cancer being the cause of achalasia.
WHAT IS THE TREATMENT?
Treatment is solely palliative. Current medical and surgical therapeutic options aim to decrease pressure on the lower sphincter of the oesophagus and to facilitate oesophageal drainage.