What Happens if Achalasia Is Left Untreated?

Achalasia cardia is a rare but serious disorder of the esophagus, the tube that carries food from the mouth to the stomach. For patients with achalasia cardia, the lower sphincter muscles (LES) fail to relax properly, and the muscles in the esophagus lose their ability to push the food downward. This leads to a range of symptoms, like swallowing difficulty, chest discomfort and regurgitation of undigested food.

While achalasia cardia progresses slowly, leaving it unaddressed leads to serious complications that make treatment difficult, thereby affecting long-term health. 

Hence, if you are someone dealing with achalasia cardia, make sure to get timely achalasia cardia surgical treatment to prevent the risks. 

What Causes Achalasia Cardia?

Achalasia cardia occurs when the myenteric nerve plexus of the esophageal wall deteriorates and loses functional activity, thereby causing esophageal peristalsis. This contraction is responsible for moving the food down the esophagus and for relaxing the lower sphincter muscles to allow the food to enter the stomach. 

While the exact cause of achalasia cardia is unknown, it results from chronic and progressive loss of esophageal function. Some of the possible underlying causes of the condition are as follows:

Genetic predisposition: In some individuals, achalasia cardia runs in families or is associated with genetic conditions. 

Autoimmune disorders: The body’s immune system may mistakenly attack and destroy the nerves in the esophagus.

Viral infections: Research indicates that viral infections (like herpes or measles) may trigger nerve degeneration in genetically predisposed individuals.

Symptoms of Achalasia Cardia

In the early stages, achalasia cardia is present with the following symptoms:

• Difficulty in swallowing 
• Acid reflux
• Regurgitation of food that is undigested
• Chest pain or discomfort 
• Persistent coughing, especially after eating 
• Progressive dysphagia to not just solids but also liquids
• Aspiration/aspiration pneumonia
• Weight loss
• Heartburn-like symptoms

Many patients mistake these signs for GERD, which eventually leads to delayed diagnosis and treatment. 

Complications of Untreated Achalasia Cardia

Neglecting treatment, particularly achalasia cardia surgical treatment, often results in severe complications. One of the primary issues is the inability of LES to relax and the loss of normal esophageal peristalsis, which causes the foods and liquids to accumulate in the esophagus. 

Prevalent complications include:

Malnutrition and weight loss: The lack of adequate nutrient intake leads to poor nutrient intake and weight loss. 

Chronic regurgitation: The undigested food and saliva constantly come back to the throat or mouth, especially when lying down.

Aspiration pneumonia: The regurgitated food or liquids can get into the lungs or airways, triggering infections and breathing issues. 

Long-term issues are as follows:

Esophageal cancer: Untreated achalasia puts an individual at an increased risk of developing esophageal cancer, particularly squamous cell carcinoma.

Esophagitis: Chronic inflammation of the esophagus gradually results in scarring and ulceration.

GI Bleeding: Bleeding from the esophagus is another major risk. 

Treatment Options

The most effective solution for achalasia is achalasia cardia surgical treatment.

Heller myotomy is a minimally invasive surgical procedure where the lower esophageal sphincter is cut, allowing food to pass more easily into the stomach. It has improved morbidity and faster recovery times. 

For patients with mild symptoms, the following non-surgical options also work. 

Botox injections: This technique involves pushing a maximum of 100 units of toxin using a sclero-needle close to the squamo-columnar junction to temporarily paralyse the LES muscle. The response rate is quite high for the first months, which gradually decreases. 

Pneumatic dilation: Here, a balloon is used to forcibly widen the sphincter. It has a success rate of 55-70 per cent for single dilation but might require repeat sessions.

Medications: Nitrates or calcium channel blockers are prescribed, though they have side effects. 

Conclusion

If you or a loved one is experiencing symptoms of achalasia, don’t wait. Get in touch to seek evaluation from a gastrosurgeon to explore the right treatment option before complications arise.