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Medical condition

Achalasia of the esophagus

Achalasia of the oesophagus is a rare motor disorder in which the lower sphincter of the oesophagus fails to relax properly during swallowing. Food and liquids then struggle to flow down to the stomach, accumulating in the esophagus and causing progressive discomfort. This condition is chronic and requires appropriate medical treatment.

What are the symptoms?

Symptoms often set in gradually over several months or years. The most frequent symptoms are :

  • Dysphagia: difficulty swallowing both solids and liquids
  • Regurgitation of undigested food, especially at night
  • Pain or pressure in the chest after meals
  • Involuntary weight loss due to eating difficulties
  • Nocturnal cough or recurrent aspiration pneumonia
  • Heartburn unresponsive to usual treatments

What are the causes?

The exact cause of achalasia remains poorly understood. There is progressive destruction of the neurons that control relaxation of the lower esophageal sphincter. Several factors are being studied:

  • Autoimmune process attacking nerve cells in the esophagus
  • Viral infection triggering a chronic inflammatory reaction
  • Genetic predisposition in rare family cases
  • Parasitic infection with Trypanosoma cruzi (Chagas disease) in secondary forms

How is it diagnosed?

Review What it assesses Usefulness
Esophageal manometry Sphincter pressure and motility Reference examination to confirm diagnosis
Barium transit Morphology and emptying of the esophagus Visualizes the characteristic bird's beak constriction
Upper GI endoscopy Esophageal and gastric mucosa Excludes tumor or other organic cause

What are the treatment options?

There is no curative treatment to restore nerve function. Treatments aim to reduce sphincter pressure and improve the passage of food:

  • Pneumatic dilatation: balloon inflation to enlarge the sphincter
  • Heller myotomy: surgical sectioning of sphincter muscle fibers
  • Endoscopic per-oral myotomy (POEM): a minimally invasive endoscopic technique
  • Botulinum toxin injections in the sphincter for temporary relief
  • Medications (calcium channel blockers, nitrates) for mild cases or frail patients
ℹ️ Achalasia is a progressive condition that does not heal spontaneously. Left untreated, it can lead to significant dilatation of the esophagus, slightly increasing the risk of esophageal cancer in the long term. Regular medical follow-up is recommended after each operation.

When to consult?

Any persistent difficulty swallowing, whether or not accompanied by regurgitation or chest pain, warrants medical evaluation. The earlier the diagnosis, the better the chances of preserving esophageal function.

Where to consult in Quebec

Clinique Omicron's healthcare professionals can assess your digestive symptoms, direct you to the appropriate tests and refer you to the appropriate specialists. Consult one of our points of service in Quebec for appropriate care.

The content of this page is provided for informational purposes only and is not intended to replace the advice of a qualified healthcare professional. Consult a physician for any symptoms, questions or decisions you may have regarding your health.

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