Understanding Achalasia and Akathisia: An Intimate Exploration

When Achalasia and Akathisia occupy the same discourse, the experience can be remarkably poignant—a narrative of internal turmoil and discomfort. While Achalasia is a daunting condition that affects the esophagus, leading to swallowing difficulties and unexpected weight loss, Akathisia, on the other hand, is a rare, often distressing experience typically associated with neurological and psychiatric disorders.

What is Achalasia?

Achalasia is a condition that impacts the esophagus. The lower esophageal sphincter (LES) is a strong muscular ring that normally relaxes to allow food to pass from the throat to the stomach. However, in individuals with achalasia, the LES fails to open during swallowing. Consequently, food and liquid become trapped in the esophagus, causing a backup.

The condition is typically connected to damaged nerves in the esophagus, leading to chest pain and difficulty swallowing (dysphagia). Over time, this condition may contribute to unintentional weight loss, hence sometimes referred to as weight loss surgery.

Causes and Manifestations of Achalasia

The exact causes of achalasia are not fully understood. It can be either innate or the result of an autoimmune response, where the body's immune system mistakenly attacks healthy cells. As a result, the degeneration of nerves in the esophagus can lead to the hallmark symptoms of achalasia.

Common Symptoms

Swallowing Difficulty: Known as dysphagia, this is the primary symptom of achalasia. Chest Pain: Often described as a sharp, burning sensation in the chest. Unintentional Weight Loss: Due to difficulty swallowing and eating enough. Vomiting: Particularly transformed or undigested food, as it is pushed back up from the stomach. Regurgitation: Of acid or undigested food.

Experiencing Achalasia: A Personal Account

From personal experience, the symptoms of achalasia can be extremely painful and disruptive. The pain often feels like a ‘bear trap snapping shut’, particularly during the first swallow of food. This painful experience can last for several seconds to a minute and requires the muscles to tire out before the squeezing can subside.

It is not uncommon for the pain to be so severe that it feels like the esophagus is about to tear open in the chest. These episodes can occur every two to three days, making dinner a truly eventful and unpredictable experience. Over time, the pain may subside, but the symptoms shift to a ‘feeling of something being out of sync’, which can lead to a vomiting reflex.

At times, the individual may experience vomiting multiple times a day, especially in severe cases. I recall one instance where I vomited uncontrollably about 20 times in a row. The intensity of the pain is now less acute, but the need to ‘jump up from my meals to run to the bathroom’ remains a significant inconvenience. Eating in public becomes even riskier, as planning the path to the bathroom in advance is often necessary.

Managing and Treating Achalasia

Managing achalasia often involves a combination of medical treatments and surgery. Laparoscopic Heller’s myotomy is a common surgical procedure that may be recommended for individuals with severe symptoms.

Laparoscopic Heller’s myotomy involves making small incisions in the abdomen through which a laparoscope is inserted. The muscle fibers of the esophagus are cut, allowing the LES to relax and function normally. This procedure can significantly improve swallowing and reduce the need for regurgitation and vomiting.

While the surgery is generally effective, it is not without risks and may require prolonged recovery time. Following the procedure, individuals must closely monitor their symptoms and adjust their diet and lifestyle to avoid further complications.

Conclusion

Suffering from Achalasia can be a harrowing experience, filled with relentless physical pain and a constant need for unpredictable bathroom breaks. Through understanding the nature of this condition and exploring current treatments, individuals can take steps towards alleviating their symptoms and improving their quality of life.