Achalasia on Esophogram

Achalasia is a disorder where the lower part of the esophagus is narrowed and fails to let food through into the stomach.  Patients with Achalasia often have swallowing difficulties, reflux and pain.  These patients will often be referred for barium esophograms to determine the cause.   This disorder most commonly occurs in middle to old age.

This disorder results in failure of the lower esophageal sphincter to relax.  There are elevated pressures in this region.   This is thought to be from destruction of the nerves in this region.  The esophagus loses its ability to propel food and becomes unusually still.   Patients often present with swallowing difficulties to all foods.  There is chest pain and eventual regurgitation of food since it doesn’t pass.

Complications can occur.  This can be a fungal esophagitis or inflamed esophagus from the chronic stasis of food.  Esophageal cancer can occur from the constant irritation of the wall from foods that don’t pass into the stomach.  Many patients are prone to aspiration of having food materials go into the lungs.  This can result in aspiration pneumonia.

On esophogram, classic findings will be a widened esophagus that is unusually still and not propelling food.  The esophagus near its lower part near the stomach will be narrowed, described as a birds beak sign.   A column of barium will form in the esophagus because it doesn’t pass.  There will be very slow passage of the barium contrast into the stomach.

One of the major complications and mimics of this condition is esophageal cancer.   Esophageal cancer can also cause narrowing of the esophagus near the bottom, at its junction with the stomach.  Cancer can also cause a widened esophagus and narrowing near the junction with the stomach.  Often, the lining of the esophagus will be more irregular with cancer.  Ultimately, endoscopy will be needed for definitive diagnosis.

Treatments range from lifestyle changes to surgery.  Dilation of the esophagus, medicines, botulinum toxin injections, or surgery to the bottom of the  esophagus where it meets the stomach.   A gastroenterologist or specialized surgeon can direct care and determine which treatment option is best.