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Achalasia is a condition of loss of the ability of the esophagus to push food or drink from the mouth to the stomach. This disease is classified as a rare disease and can affect people of all ages, both men and women.

Achalasia occurs when nerves in the wall of the esophagus that connect the mouth to the stomach are damaged and stop functioning normally. Generally, the lower esophageal sphincter (LES) will open automatically so that food can enter the stomach. However, in people with achalasia, LES does not open and close normally, so food accumulates in the lower part of the esophagus or rises back to the base of the esophagus.
The main cause of damage to LES is not yet known. However, there are several factors that are thought to have the potential to increase the risk of achalasia, including:
  • Immune system disorders. Achalasia is thought to be caused by an immune system error that attacks the esophageal nerve cells, resulting in decreased function of the esophagus.
  • Heredity factor. Acalacia is thought to be derived from an elderly person with achalasia.
  • Viral infection. For example, the herpes virus.
Symptoms of achasia appear gradually. Over time, the function of the esophagus will become weaker and some symptoms will appear as follows:
  • Dysphagia, a condition when people with achalasia have difficulty, even pain, when swallowing food or drinks.
  • Heartburn, is a feeling of burning or burning in the pit of the stomach due to stomach acid which rises into the esophagus.
  • Regurgitation, a condition when food or drink returns to the throat.
  • Chest pain.
  • Vomiting that flows or drips from the mouth.
  • Weight loss.
If the symptoms of achalasia continue to be left without treatment, it will increase the risk of esophageal cancer.

Achalacia has symptoms similar to those of other digestive disorders. As a first step, the doctor will examine the medical history and symptoms that the patient feels. Then, the doctor will do a physical examination especially to see the function of swallowing the patient.
To ensure a diagnosis, the doctor may carry out further examinations, including:
  • One type of imaging test to get detailed images of the esophagus. Patients will be asked to swallow liquid (contrast) substances containing barium, so that the esophagus can be clearly seen when X-rays. Normally, the diameter of the esophagus looks quite wide and the barium looks smoothly entering the stomach. However, this is not the case for achalasia sufferers.
  • A small and flexible plastic tube will be inserted into the esophagus through the nose. This tool will record the activity and strength of muscle contractions, as well as check the pressure that appears on LES.
  • A flexible instrument with a camera at the end will be inserted into the lower part of the esophagus so that doctors can check the condition of the esophagus and stomach wall.
Achalasia treatment aims to reduce the symptoms felt by patients, to open LES muscles so that food and drinks can enter easily into the stomach, and prevent complications. There are several types of treatment for people with achalasia, including:

Widening of the esophagus. This procedure is done by inserting a balloon into the part of the esophagus that has narrowed with the help of an endoscope. The balloon is then developed to enlarge the LES opening, so that food can enter the stomach. This action needs to be done repeatedly to get the best results.

Botox injection (botulinum toxin). This type of treatment is carried out for patients with general health conditions that are not good, so it is not possible to do esophageal dilation. The doctor will inject botox directly into LES via endoscopy, so that the LES will relax and open. The effect of Botox injections is only temporary, can last for several months and sometimes several years.

Operation. The surgical procedure to open LES is known as myotomy. There are several types of myotomy to treat achalasia, including:
  • Heller myotomy. This procedure is done by cutting the LES muscle using a laparoscopic technique or minimal incision surgery, so that the food is easier to enter the stomach.
  • Oral endoscopic myotomy (POEM). This procedure is done using an endoscope that is inserted through the mouth into the esophagus to cut LES.
  • The surgeon will wrap the upper part of the stomach (below LES) to tighten the stomach muscles and prevent stomach acid from rising. This surgical procedure is usually performed together with Heller myotomy through laparoscopic techniques.
In addition, the administration of medicines can also be done by the doctor if the patient's condition is not possible to go through the esophageal dilation procedure or surgery, and if botox injection is also not helpful. Medications that can be given to relax LES include nitroglycerin or nifedipine, which is taken before meals.

There are several complications that can be experienced by people with achalasia, including:
  • Aspiration pneumonia, occurs when food or liquid enters the lungs and causes infection.
  • Esophageal perforation, the condition of tearing of the esophageal or esophageal wall. Esophageal perforation can cause life-threatening infections in patients.
  • Oesophageal cancer. Akalasia is at risk for esophageal cancer.
Achalacia is difficult to prevent, but sufferers can prevent complications, including:
  • Increase drinking while eating.
  • Chew food well before swallowing.
  • Eat a smaller and more frequent diet.
  • Avoid eating before bed, give a minimum of 3 hours before bedtime.
  • Avoid sleeping in a flat position. Use a pillow to support your head, this is done to prevent stomach acid from rising into the esophagus.
  • Quit smoking.


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