Many people with achalasia first notice something’s wrong when they have trouble swallowing or feel like food is getting stuck in their chest. You might also experience heartburn, chest pain, or food coming back up after eating. At first, these symptoms can seem mild, and it’s easy to think they’re just caused by something like indigestion or acid reflux. However, when these symptoms don’t go away or get worse over time, they could be signs of a condition called achalasia. This is a rare problem where the muscles in your esophagus don’t work right, making it hard for food and liquids to move into your stomach. While it can be frustrating, the good thing is that there are treatments available that can help make swallowing easier and relieve discomfort.
In this blog, we’ll explore the top treatment options for achalasia, including everything from medications and non-invasive procedures to advanced surgeries. Whether you’re just learning about the condition or are looking for options after unsuccessful treatments, this guide will help you understand how to manage your symptoms and regain control of your eating and drinking habits.
What is Achalasia?
Before diving into treatment options, it’s crucial to understand that achalasia is a progressive condition that can significantly impact your quality of life if left untreated. As time goes on, the symptoms tend to worsen, making it harder to eat, drink, and even breathe comfortably. Early detection and treatment are key to managing the condition and preventing further complications. Common symptoms of achalasia include:
- Difficulty swallowing (dysphagia)
- Regurgitation of undigested food
- Chest pain
- Weight loss
- Heartburn
- Coughing, especially at night
Treatment Options of Achalasia You Should Know
Managing achalasia often involves two main approaches: medications to relieve symptoms and surgical procedures to address the root cause. The choice of treatment depends on the severity of the condition and the patient’s overall health. Let’s explore these options in detail.
Medication Options for Achalasia
While medications do not provide a permanent cure for achalasia, they can help manage symptoms by relaxing the muscles of the esophagus and easing the passage of food into the stomach.
1. Nitrates (Isosorbide Dinitrate)
Nitrates are medications that help relax the lower esophageal sphincter (LES), the muscle that doesn’t open properly in people with achalasia. By relaxing this muscle, nitrates can make it easier to swallow and reduce chest pain.
While they work for some people, the relief they provide is usually temporary, and side effects like headaches or low blood pressure can happen. Nitrates are often taken under the tongue for quick relief, but over time, the body may get used to them, and they may not be as effective.
For this reason, they’re typically used for short-term relief or alongside other treatments. It’s important to keep track of any side effects and talk to your doctor if they become a problem.
2. Calcium Channel Blockers (Nifedipine)
Nifedipine works by relaxing the smooth muscles of the esophagus, which helps food pass more easily into the stomach. It is a common option that can lower the pressure in the esophagus and reduce symptoms.
Like nitrates, Nifedipine can provide short-term relief, but they don’t always work for everyone, and side effects like dizziness or swelling may occur. They’re usually taken before meals to make swallowing easier.
Some people may feel tired or notice their blood pressure drops while using them, which can be inconvenient. Because of these limitations, calcium channel blockers are often used as a temporary solution while considering other treatment options.
3. Botulinum Toxin (Botox) Injections
Botox injections are used directly in the lower esophageal sphincter to relax the muscles and stop spasms. By blocking the nerve signals that make the muscles tighten, Botox helps improve swallowing. However, the effects are usually temporary, so multiple injections may be needed to maintain relief.
Botox is a good option for people who cannot undergo surgery. It’s a quick, minimally invasive procedure with little to no recovery time. This treatment is especially useful for older patients or those with medical conditions that make surgery risky.
Over time, though, repeated treatments may become less effective, so it’s important to discuss your long-term options with your doctor.
Surgical Options for Achalasia
For patients who do not respond well to medications or less invasive treatments, surgery may be the best option. Surgical interventions can provide long-lasting relief by directly addressing the underlying issue of muscle dysfunction in the esophagus.
1. Heller Myotomy (Laparoscopic Approach)
The most common surgery for achalasia is Heller myotomy. It involves cutting the muscles of the lower esophageal sphincter so they can relax and allow food to pass more easily. This surgery is usually done laparoscopically, meaning through small cuts, which helps reduce recovery time and improve accuracy.
Often, a partial fundoplication is also done to stop acid reflux after the surgery. While Heller myotomy provides significant relief, some patients might still have reflux after the procedure. Most people feel a big improvement in their swallowing and quality of life, but, like any surgery, there are risks, like bleeding or infection.
Most patients can get back to their regular activities in a few weeks, but they should avoid heavy lifting while they recover.
2. Peroral Endoscopic Myotomy (POEM)
Peroral Endoscopic Myotomy (POEM) is a simple surgery that uses an endoscope to perform a myotomy. Instead of making cuts on the outside of your body, the surgeon makes cuts inside the esophagus to relax the muscles.
The advantage of POEM (Peroral Endoscopic Myotomy) is that it doesn’t require large external incisions, which means less scarring and a faster recovery. This technique has been very effective for many people with achalasia. Since it’s done through the mouth, there’s no need for big cuts or stitches.
Recovery time is usually quicker than with traditional surgery, and complications are less frequent. While POEM is still relatively new, early results are promising, though long-term outcomes are still being studied.
3. Esophagectomy
In some cases, when other treatments don’t work or the esophagus is very damaged, an esophagectomy may be needed. This surgery involves removing the esophagus and creating a new pathway for food to move from the mouth to the stomach.
Esophagectomy is usually a last resort because it’s complex and comes with serious risks. Recovery can take a long time and may require a hospital stay of several weeks. Patients might also need rehabilitation to adjust to changes in how they digest food. Because of its seriousness, this option is generally only considered when all other treatments have failed.
Lifestyle Modifications and Dietary Changes to Deal With Achalasia
While not a direct treatment for achalasia, certain lifestyle changes and dietary modifications can help alleviate symptoms and make swallowing easier. These changes include:
1. Eat Smaller, Frequent Meals
Instead of eating large meals, try eating smaller meals more often throughout the day. This can help reduce the pressure on your lower esophageal sphincter (LES), making it easier for food to pass through. Smaller meals also prevent food from getting stuck in the esophagus, helping to keep things moving smoothly and prevent many digestive issues overall.By eating more often, you can also avoid feeling too full, which can lead to discomfort.
2. Avoid Hard-to-Swallow Foods
Some foods, like bread, meat, or tough vegetables, can make swallowing a lot harder and cause food to get stuck. Choosing softer, easier-to-swallow foods is a good way to reduce the strain on your esophagus. Foods that are pureed, mashed, or well-cooked are often easier to manage, as they break down more easily in your mouth and require less effort to swallow.
3. Drink Plenty of Fluids
Make sure to drink enough liquids with your meals. Water, herbal teas, and other non-carbonated drinks can help soften the food, making it easier to swallow and pass through the esophagus. Drinking liquids can also help keep your body hydrated and support overall digestion, promoting better nutrient absorption and reducing discomfort. Just be sure to avoid sugary or carbonated drinks, as they can cause bloating and discomfort.
4. Eat Slowly and Chew Well
Taking your time while eating and chewing your food thoroughly can make a big difference. When you chew food well, it’s easier to swallow and digest, and it reduces the pressure on your LES. Eating too quickly can lead to food getting stuck or uncomfortable bloating. Slow down, savor your meals, and make sure your food is well-chewed before swallowing.
Treat Achalasia With Experts
While there is no cure for achalasia, there are several treatment options available to manage the condition and improve your quality of life. The right treatment depends on the severity of the disease, your overall health, and your preferences. Right medications can offer relief, while surgery may be needed for more severe cases. If you or a loved one are dealing with achalasia symptoms, it’s important to talk to a healthcare provider who specializes in gastroenterology. You can get expert advice from a gastroenterologist in Centurion to find the best treatment for your needs. Early consultation can help you manage the condition better and improve your daily life.