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$Unique_ID{BRK03410}
$Pretitle{}
$Title{Achalasia}
$Subject{Achalasia Cardiospasm Dyssynergia Esophagus Esophageal Aperistalsis
Megaesophagus Gastroesophageal Reflux Hiatal Hernia}
$Volume{}
$Log{}
Copyright (C) 1986, 1993 National Organization for Rare Disorders, Inc.
118:
Achalasia
** IMPORTANT **
It is possible that the main title of the article (Achalasia) is not the
name you expected. Please check the SYNONYMS listing to find the alternate
name and disorder subdivisions covered by this article.
Synonyms
Cardiospasm
Dyssynergia Esophagus
Esophageal Aperistalsis
Megaesophagus
Information on the following diseases can be found in the Related
Disorders section of this report:
Gastroesophageal Reflux
Hiatal Hernia
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Achalasia is a rare disorder of the esophagus characterized by the
abnormal enlargement of the esophagus, impairment of the ability of the
esophagus to push food down toward the stomach (peristalsis), and the failure
of the ring-shaped muscle (sphincter) at the bottom of the esophagus to
relax.
Symptoms
The symptoms of Achalasia typically appear gradually. People with this
disorder may initially experience an impairment in the ability to swallow
(dysphagia). Early symptoms of this disorder may include mild pain in the
chest that comes and goes. Others may experience pain that is overwhelming
and agonizing. The contents of the stomach may be brought up (regurgitated)
or be propelled into the lungs while breathing (tracheobronchial aspiration).
Regurgitation of stomach contents is reported in approximately one-third of
people with Achalasia. Other symptoms of this disorder may include a cough
during the night and significant weight loss in cases that remain untreated.
The aspiration of stomach contents in people with Achalasia may cause
pneumonia and other pulmonary infections. Cancer of the esophagus may occur
in approximately 5 percent of cases of Achalasia.
X-ray examination (radiology) is frequently useful in the diagnosis of
Achalasia. Radiological examination, especially with the use of barium, may
show enlargement (dilation) of the esophagus and the retention of food and
secretions within the esophagus. Devices that measure fluid pressure
(manometric examination) within the esophagus may also be useful in the
diagnosis of this disorder. Stimulation of the esophagus with drugs or
examination with an illuminated optic instrument (endoscopy) are not advised
when Achalasia is suspected.
Causes
The exact cause of Achalasia is not known. The condition may be caused by
degeneration of a group of nerves located in the chest (Auerbach's plexus).
It has been suggested that in some cases, Achalasia may be inherited as
an autosomal recessive genetic trait. Human traits, including the classic
genetic diseases, are the product of the interaction of two genes, one
received from the father and one from the mother. In recessive disorders, the
condition does not appear unless a person inherits the same defective gene
for the same trait from each parent. If one receives one normal gene and one
gene for the disease, the person will be a carrier for the disease, but
usually will not show symptoms. The risk of transmitting the disease to the
children of a couple, both of whom are carriers for a recessive disorder, is
twenty-five percent. Fifty percent of their children will be carriers, but
healthy as described above. Twenty-five percent of their children will
receive both normal genes, one from each parent, and will be genetically
normal.
Affected Population
Achalasia is a rare disorder that typically affects adults between the ages
of 20 and 40 years. However, this disorder may occur at any age. Achalasia
affects males and females in equal numbers except in those cases that are
thought to be inherited. In familial cases of Achalasia, males are twice as
likely as females to be diagnosed with this disorder.
Related Disorders
Symptoms of the following disorders can be similar to those of Achalasia.
Comparisons may be useful for a differential diagnosis:
Gastroesophageal Reflux is a common gastrointestinal disorder
characterized by the backward flow of the contents of the stomach and/or the
small intestine into the mouth. The most common symptom of this disorder is
a sensation of warmth or burning in the chest and/or neck area. This usually
occurs at night. Patients may complain of wheezing at night, hoarseness, and
a need to clear the throat repeatedly. There may also be a sensation of deep
pressure at the base of the neck. (For more information on this disorder,
choose "Gastroesophageal Reflux" as your search term in the Rare Disease
Database.)
Hiatal Hernia is a very common digestive disorder. Symptoms may include
a flow back (reflux) of stomach contents into the esophagus (gastroesophageal
reflux), pain and a burning sensation in the throat. The opening in the
diaphragm becomes weakened and stretched, allowing a portion of the stomach
to bulge through into the chest cavity. This disorder can easily be
diagnosed through testing by a radiologist.
Therapies: Standard
The treatment of Achalasia is aimed at removing obstructions caused by the
failure of the lower esophageal sphincter muscle to relax. This may be done
with the administration of drugs, physical enlargement (manual dilation) of
the sphincter muscle, or through surgery.
The drug isosorbide, (a long-acting nitrate) or nifedipine (a calcium
channel blocker) may provide some relief for people with Achalasia.
Approximately 85 percent of cases of Achalasia may be treated effectively
by the enlargement of the lower esophageal sphincter muscle through a
procedure known as balloon dilation. This is a complicated procedure. In
some people, repeated dilations may be necessary to obtain relief of
symptoms.
Surgical treatment of Achalasia may be effective in approximately 85
percent of cases. During this procedure, the muscle fibers in the lower
esophageal sphincter are cut (Heller myotomy). About 15 percent of people
with Achalasia experience the symptoms of gastroesophageal reflux after this
surgical procedure.
Therapies: Investigational
Please contact the agencies listed under the Resources section of this report
for the most current information.
This disease entry is based upon medical information available through
January 1993. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Achalasia, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
National Digestive Diseases Information Clearinghouse
Box NDDIC
Bethesda, MD 20892
(301) 468-2162
National Institute of Diabetes, Digestive & Kidney Disease Information
Clearinghouse
Box NCID
Bethesda MD 20892
(301) 496-3583
For Genetic Information and Genetic Counseling Referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
MENDELIAN INHERITANCE IN MAN, 10th Ed.: Victor A. McKusick, Editor: Johns
Hopkins University Press, 1992. Pp. 92-94.
CECIL TEXTBOOK OF MEDICINE, 19th Ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1990. Pp. 643-646.
THE MERCK MANUAL, 16th Ed.: Robert Berkow Ed.; Merck Research
Laboratories, 1992. Pp. 747.
BIRTH DEFECTS ENCYCLOPEDIA, Mary Louise Buyse, M.D., Editor-In-Chief;
Blackwell Scientific Publications, 1990. Pp. 641.
PRIMARY TREATMENT OF ESOPHAGEAL ACHALASIA. LONG-TERM RESULTS OF MYOTOMY
AND DOR FUNDOPLICATION: L. Bonavina; Arch Surg (Feb. 1992; 127(2)). Pp. 222-
226.
ACHALASIA: NEW THOUGHTS ON AN OLD DISEASE: C.M. Farr; J Clin Gastroenterol
(Jul 1992; 15(1)). Pp. 2-4.