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Researchers believe the cause is a reduced number of inhibitory nerve cells, the specialized neurons that direct involuntary muscle tissue to relax. The resulting imbalance allows excitory nerve cells (neurons that direct involuntary muscle tissue to contract) to dominate. Over time the peristaltic action of the esophagus, a structure of involuntary muscle tissue, slows as well.
Symptoms and Treatment
Symptoms of achalasia include
- Painful or difficult swallowing
- Regurgitation of swallowed food
- Dyspepsia (heartburn)
- Pain in the central chest and beneath the sternum (breastbone) after eating
- Unintended weight loss
Barium swallow can suggest the diagnosis, with manometry (which measures the pressure within the esophagus) providing confirmation. The gastroenterologist may also perform esophagogastroduodenoscopy (EGD), an endoscopic examination of the upper gastrointestinal tract, to rule out cancers and to use balloon dilation to gently stretch the sphincter.
Some people experience relief with medications, such as calcium channel blockers, which block the actions of excitory neurotransmitters to help relax the lower esophageal sphincter. Botulinum therapy, in which the gastroenterologist injects botulinum toxin into the sphincter to paralyze it, can provide temporary relief.
The treatments of choice for short-term relief are disruption of the lower esophageal sphincter, in which the gastroenterologist uses special instruments to widen the sphincter, or esophagomyomotomy, a surgical operation to cut a portion of the sphincter.
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