Definition
Achalasia is a rare esophageal disorder also known as idiopathic megaesophagus. This disorder is characterized by absent or abnormal peristalsis in the esophagus and absent or incomplete relaxation of the lower esophageal sphincter (LES) during swallowing. In the absence of disease, peristalsis is the series of muscle contractions that allow food to move through the esophagus, and the LES is the muscle between the esophagus and the stomach that opens to let food enter the stomach during swallowing, then closes to prevent food and stomach acid from flowing back into the esophagus. In individuals with achalasia, the altered peristalsis and LES hypertension cause food to remain stuck in the esophagus.
Etiology
Achalasia results from a dysfunction of the nerves responsible for esophageal peristalsis. However, the cause of this dysfunction is unknown. It may be due to viral exposure or have an autoimmune origin.
Symptoms
The main symptom of achalasia is dysphagia for solids and liquids. This difficulty swallowing results from the progressive dilation of the esophagus caused by LES hypertension. Achalasia can also cause less common symptoms such as difficulty or pain when swallowing, nighttime regurgitation, chest pain, heartburn, a feeling of fullness due to inadequate emptying of the esophagus, and weight loss or malnutrition.
Treatment
The main treatments for achalasia include pneumatic dilation, surgical myotomy, peroral endoscopic myotomy (POEM), and botulinum toxin injection. However, none of these treatments can restore esophageal peristalsis. Their goal is to improve disease symptoms by reducing LES pressure and thus the obstruction. This allows food to pass again from the esophagus to the stomach.
General nutritional recommendations
Nutritional recommendations that may help reduce achalasia symptoms include:
- Eating foods that are easy to swallow such as those with a soft, pureed, or liquid texture and low in fiber, as fiber slows emptying.
- Having several small meals.
- Avoiding hard foods like meat, sticky, and spicy foods.
- Also avoiding citrus fruits and alcohol.
- Favoring a diet high in fats and moderate in proteins. Fats help relax the LES but delay gastric emptying, so their amount should be adjusted according to individual tolerance.
- Avoid bending over or lying down after meals and eat slowly to prevent reflux.
- Alternating liquids and solids during meals can help transport food to the stomach.
Nutritional recommendations after pneumatic dilation
Following this procedure, nutritional recommendations include:
- Not eating or drinking for one hour after treatment.
- Starting with light, semi-liquid meals, then progressing to solid meals the next day, depending on individual tolerance.
Nutritional recommendations after myotomy
The progression of diet after myotomy varies depending on the technique used (surgical myotomy or POEM). In general, nutritional recommendations are as follows:
- Following a liquid diet for the first 24 hours after the procedure.
- Progressing to a normal diet over 5 to 7 days depending on individual tolerance.
- Ensuring adequate energy and protein intake to promote tissue healing.
- Monitoring for complications that may occur after the procedure, such as gastroesophageal reflux or persistent symptoms.
- Individualizing treatment.
If you want more information about achalasia, do not hesitate to consult a healthcare professional who can provide support tailored to your personal situation.
References
- Bouthillier, Lise. January 2019. "Digestive Tract Diseases." NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.
- https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/troubles-%C5%93sophagiens-et-de-la-d%C3%A9glutition/achalasie
- https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/maladies-de-l%E2%80%99%C5%93sophage-et-de-la-d%C3%A9glutition/achalasie?query=Achalasie
- https://www.chumontreal.qc.ca/sites/default/files/2020-04/258-3-achalasie-de-l-oesophage.pdf
Article written by:
Marie-Noël Marsan, written in 2021.