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Achalasia

Achalasia

Achalasia is a swallowing disorder caused by loss of function in the lower esophageal sphincter (the muscular ring at the junction of the esophagus and the stomach). Normally, when people swallow, the sphincter relaxes to allow food and liquid to pass into the stomach. With achalasia, the sphincter does not relax, which causes food to be lodged in that area.

Symptoms of Achalasia

Achalasia can cause these symptoms:

  • Coughing

  • Choking

  • Regurgitation

  • Dysphagia

  • Food retention in the esophagus 

Achalasia Diagnosis

Because achalasia is one of a number of swallowing disorders, physicians at Johns Hopkins will use diagnostic procedures to determine that achalasia is the cause of your symptoms.

Physicians at Johns Hopkins are recognized for their experience and expertise in diagnosing and treating achalasia so you can count on them to develop a treatment plan that will alleviate your symptoms. 

Your first appointment will include a thorough physical examination and recording your medical history.

Diagnostic procedures your doctor may order include: 

Endoscopy

Gastroenterologists at Johns Hopkins routinely perform endoscopies, a frequently used diagnostic procedure for swallowing disorders. Their vast experience with these tools allows for an accurate diagnosis.

Your doctor may perform an endoscopy to examine the esophagus and stomach. An endoscope is a thin, lighted tube with a camera at its tip that allows your doctor a better view of your condition.

During an endoscopy:

  1. You are sedated.

  2. Your doctor inserts a flexible endoscope through your mouth and into your esophagus.

  3. The endoscope allows your doctor to examine your stomach, duodenum (first part of your small intestine) and esophagus.

  4. Your doctor looks for abnormalities in the mucous lining (e.g., esophageal strictures [narrowing] or tumors).

  5. If necessary, your doctor can perform a biopsy or remove abnormal tissue for further analysis.

Esophageal Manometry 

An esophageal manometry evaluates the changes in pressure that happen when you swallow. During an esophageal manometry:

  1. Your doctor will pass a thin, flexible catheter through your nose or mouth, down your throat and into your stomach. While it can be slightly uncomfortable to have a tube in your nose, the test only lasts about 10 minutes.

  2. Attached to the tube are a number of pressure sensors.

  3. Using the pressure sensors, your doctor can assess your swallowing muscles in action.

  4. You start by swallowing a few sips of water, followed by applesauce or something similar.

  5. You may bring foods that trigger your symptoms; this way, your doctor can see what is happening in real-time.

Esophageal manometry provides your doctor with real-time information about:

  • Strength and coordination of the muscle movements (peristalsis) of the pharynx and esophagus.

  • Strength and relaxation function of the upper and lower esophageal sphincters. A sphincter is a muscle that opens and closes; the lower esophageal sphincter is the muscle that controls the emptying of foods from the esophagus to the stomach.

Wireless pH Testing 

Wireless pH testing allows your doctor to evaluate your reflux activity over a 48-hour period, while you are continuing your normal activities. To perform wireless pH testing:

  1. Your doctor performs an endoscopy and places a small chip in the lower esophagus.

  2. The chip records acid at that site for 48 hours.

  3. The chip transmits your acid level to a wireless recording device that you wear on a belt.

  4. The recording device is sent to your doctor who downloads the data and can gauge your reflux severity. 

Treatment for Achalasia at Johns Hopkins

Treating achalasia focuses on procedures that enable the esophageal sphincter to relax and allow food to pass through, offering patients relief from symptoms that make eating difficult. Your doctors at Johns Hopkins may recommend dilation, surgery or an injection, depending on your symptoms and diagnosis. Learn more about each of these treatments for achalasia at Johns Hopkins.

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