The Common Causes of Achalasia

Achalasia (dysphagia) is a rare disorder in which the esophagus can't pass food and liquids to the stomach. The esophagus is the muscular tube transporting food from the mouth to the stomach. At the point where the esophagus meets the stomach, there is a ring of muscle called the lower esophageal sphincter. This muscle relaxes to open and allows food to enter the stomach, and it contracts to close and prevent stomach contents from returning to the esophagus. If you have achalasia or dysphagia, the lower esophageal sphincter does not relax, preventing food from moving into your stomach.

Achalasia occurs when the esophagus becomes paralyzed and dilates over time, eventually losing its ability to push food down into the stomach. As a result, food accumulates in the esophagus and can sometimes ferment due to bacterial action, causing a bitter taste when it returns to the mouth. Some people mistakenly think this condition is gastroesophageal reflux disease (GERD). However, in achalasia, food refluxes from the esophagus, while in GERD, acidic substances reflux from the stomach.

Achalasia is a rare condition occurring in about 1 in 100,000 people. The exact cause of dysphagia or achalasia is not well understood. However, researchers have discovered several theories, the most prominent of which are:

- Achalasia is believed to occur when the nerve cells located between the layers of the esophageal muscles become damaged and stop functioning properly. This is why the muscles and the muscle ring do not work effectively. The health of these nerve cells in the esophagus is essential for pushing food toward the stomach.

- In some individuals, achalasia may be associated with a viral infection. People with dysphagia often have evidence of past infections, such as antibodies to herpes simplex virus, measles virus, and others.

- Achalasia may also be associated with autoimmune diseases, where the body's immune system attacks healthy cells, tissues, and organs. Researchers have found signs of immune system activity in the nerve cells that support the esophageal muscles. Additionally, patients with dysphagia are 3.6 times more likely to have autoimmune disorders such as uveitis, type 1 diabetes, rheumatoid arthritis, and lupus.

- In rare cases, achalasia may be caused by a genetic disorder. 
Achalasia is a rare swallowing disorder that is a lifelong condition and can have severe symptoms that worsen over time, leading to persistent vomiting, severe chest pain, and significant weight loss. With Dr. Shaimaa El Kholy, Associate Professor of Advanced Interventional Gastrointestinal Endoscopy (ESD & Third Space Endoscopy), Faculty of Medicine, Cairo University, this condition can be permanently resolved without surgery through Third Space Endoscopy techniques, specifically using Per Oral Endoscopic Myotomy (POEM). This method has achieved the highest success rates for all types of achalasia.

Dr. Shaimaa El Kholy inserts an endoscope through the mouth into the lower esophagus. An incision is made in the inner lining of the esophagus. The endoscope is then advanced between the layers of the esophagus until it reaches the muscle layer, the fourth layer of the esophageal wall. A section of the muscle layer in the lower esophagus, 2-3 cm below the lower esophageal sphincter, and the upper part of the stomach is incised. This reduces constriction, allowing food and liquids to pass more easily from the esophagus to the stomach.