What is Esophageal Achalasia? An ERNICA animation for patients, parents and families

This animation aims to provide you with more information about oesophageal calasia. Esophageal calasia is a rare disorder of the esophagus. When you eat, food enters and passes through a tube called the esophagus into the stomach. For this process to run efficiently, the esophagus must move in a certain way. This is called peristalsis. Before the food enters the stomach, it passes through a muscular valve, known as the cardia. This valve relaxes and opens when the swallowed food reaches it, closing afterwards to prevent contents of the stomach from flowing back upwards. In esophageal chiasia, peristalsis of the esophagus is progressively lost. The muscular valve does not relax properly, and food builds up in the esophagus and passes into the stomach with difficulty. The esophagus may also enlarge over time. Esophageal calasia can affect people of all ages. It is most commonly seen in young adults, but it can also affect older adults, teenagers, and very rarely children. The cause is unknown. Individuals with chilaia present with difficulties swallowing food and liquid. Food and saliva built up in the esophagus often travels back to the mouth. Sometimes during breathing, saliva and or food can also enter the lungs. This is called aspiration. Some affected individuals occasionally experience pain in their chest, back and shoulders, and or in their neck and lower jaw. Symptoms often occur on an irregular basis to begin with. Eventually they become more common. This often leads to weight loss or, in children, impaired growth. Repeated unexplained lung infections can also occur. A diagnosis of esophageal chiasia is often suspected using an imaging technique called an X-ray. The patient swallows a special liquid. This liquid is visible on the X-ray and is observed building up in the esophagus. Sometimes the esophagus is also larger than normal. Other causes of swallowing difficulties need to be excluded by performing an endoscopy. A long thin, flexible tube with a light and a camera is passed down through the mouth to examine the esophagus and stomach. Tissue samples called biopsies may be taken for examination under a microscope. A pressure test, also called a manometry, needs to be performed to confirm a diagnosis of esophageal chiasia. This is when a small tube is passed into the esophagus through the nose. This test measures the muscle coordination of the esophagus and the relaxation abilities of the muscular valve. Individuals with oesophageal chiasia should be treated at a specialist center by a dedicated team of different professionals. The treatment of chilasia is focused on disrupting the muscular valve's abnormal persistence to stay tight, so that food can more freely pass into the stomach. This can be done by making a cut through the valve, which is called a myotomy. And this can be achieved via a surgical procedure or via endoscopy. Alternatively, the valve can be stretched using a balloon, which is called a pneumatic dilation. Treatment options for chilaia should be discussed with your clinical team and the patient's individual circumstances should be considered. Gastroesophageal reflux is when food and acid from the stomach flows back into the esophagus. The risk of gastroesophageal reflux differs per treatment, and it is therefore necessary to discuss both the advantages and disadvantages with your clinical team. Structured regular follow-up care is essential for individuals with oesophageal chiasia, and this should be provided by specialist clinicians. Follow-up endoscopies should be included as part of this care. Identifying any complications or difficulties early is very important. Peer support can be accessed through patient and family support groups.