Definition

Achalasia is a rare disorder of the esophagus also called 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) when swallowing. In the absence of disease, peristalsis is the set of muscle contractions that allow food to move through the esophagus and the SOI is the muscle between the esophagus and the stomach that opens to let food enter. stomach when swallowing and then closes to prevent food and stomach acid from moving up into the esophagus. In individuals with achalasia, altered peristalsis and hypertension of the SOI cause food to remain blocked in the esophagus.

Etiology

Achalasia results from a dysfunction of the nerves responsible for the peristalsis of the esophagus. However, the cause of this dysfunction is unknown. It could be due to viral exposure or have an autoimmune origin.

Symptoms

The main symptom of ahalasia is dysphagia to solids and liquids. This difficulty in swallowing results from the progressive dilation of the esophagus caused by hypertension of the SOI. Achalasia may also cause less common symptoms such as difficulty or pain when swallowing, regurgitation at night, chest pain, heartburn, a feeling of fullness, due to the esophagus not emptying properly, and weight loss or malnutrition.

Treatment

The main treatments for ahalasia include pneumatic dilation, surgical myotomy, endoscopic peroral myotomy (POEM) and botulinum toxin injection. However, none of these treatments can restore the peristalsis of the esophagus. Their goal is to improve the symptoms of the disease by decreasing the pressure of the SOI and therefore the occlusion. This allows food to pass from the esophagus back to the stomach.

General nutritional recommendations

Nutritional recommendations that can help reduce the symptoms of achalasia include:

• Eat foods that are easy to swallow, such as those that are soft, mashed, or runny in texture and that are low in fiber, as fiber slows down emptying.
• Eat several small meals.
• Avoid hard foods, like meat, sticky and spicy.
• Also avoid citrus fruits and alcohol.
• Promote a diet high in lipids and moderate in protein. Lipids aid in SOI relaxation, but delay gastric emptying, so their amount should be adjusted according to the tolerance of each individual.
• Avoid bending or lying down after meals and eat slowly to prevent reflux.
• Alternating liquids and solids with meals can help transport food to the stomach.

Nutritional recommendations after pneumatic dilation

Following this intervention, nutritional recommendations include:

• Do not eat or drink within one hour of treatment.
• Start with light, semi-liquid meals, then progress to solid meals the next day, depending on individual tolerance.

Nutritional recommendations after myotomy

The progression of feeding following the myotomy varies depending on the technique used (surgical myotomy or POEM). In general, the nutritional recommendations are as follows:

• Observe a liquid diet for the first 24 hours after the procedure.
• Progress towards a normal diet over a period of 5 to 7 days depending on individual tolerance.
• Have adequate energy and protein intake to promote tissue healing.
• Pay attention to complications that may arise following the procedure, such as gastroesophageal reflux disease or the persistence of symptoms.
• Individualize the treatment.

If you would like more information about achalasia, do not hesitate to consult a healthcare professional who can offer you support tailored to your personal situation.

References

1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
2. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/troubles-%C5%93sophagiens-et-de-la-d%C3%A9glutition/achalasie
3. https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/maladies-de-l%E2%80%99%C5%93sophage-et-de-la-d%C3%A9glutition/achalasiequery= Achalasiae
4. https://www.chumontreal.qc.ca/sites/default/files/2020-04/258-3-achalasie-de-l-oesophage.pdf

Article written by:

Marie-Noël Marsan, Nutritionist