Esophageal Spasms & Achalasia
These disorders often cause
dysphagia.
Esophageal spasms are more common. They are characterized by repetitive and non-propulsive contractions; unlike achalasia, manometry will show normal sphincter responses. Spasms produce
angina-like chest pain.
Treatments include sedatives, nitrates, botulinum toxin, and surgery; unfortunately, treatment failure rates are high.
Achalasia is caused by failure of the lower esophageal sphincter to relax due to degeneration in the
myenteric plexus (in other words, the LES remains closed).
As a result, patients experience:
Regurgitation (with increased risk of aspiration and pulmonary complications).
Progressive dysphagia of both foods and liquids, with weight loss due to slower/reduced eating and drinking (although the weight loss may be mild). Notice that this is different from what we see in esophageal cancer, where patients first experience difficulty swallowing solids then difficulty swallowing liquids.
With a barium swallow test, we'll see a characteristic "bird's beak" at the distal end of the esophagus where the constricted LES creates stenosis.
In most U.S. patients, most cases of achalasia are idiopathic; adenocarcinoma of the proximal stomach is the second leading cause.
Be aware that worldwide, achalasia is most often caused by
Chagas disease.
Be aware that there are three subtypes of achalasia, which influences their treatment and outcomes.
Treatments for achalasia include surgery, botulinum toxin, and pneumatic dilation.
