September is Achalasia month ✨
Updated: May 31, 2020
What is Achalasia and how does it affect an individual? How does it relate to Speech Therapy? Keep reading below to find out.
What is Achalasia?
Achalasia is a rare disorder that affects the muscles in our oesophagus or food pipe. Achalasia occurs when the muscles don't relax enough to let food and drink through to the stomach.
If you look at the above picture, you can see that the muscles - just above the stomach, are squeezed in tight. This makes it difficult for food and drink to get to the stomach. The end result is that food and drink builds up in the oesophagus. Patients often report to their GP that they feel like food is stuck, or that it has come back up again. If you sometimes eat first and then have a drink - the drink will pile up on top of the food and then you can also bring this all back up again.
Achalasia takes some time to develop. It doesn't always occur immediately or spontaneously.
How is a Speech Therapist involved?
Speech Therapists are not traditionally involved in the management of Achalasia. However, it may be that the GP who refers you for a swallow assessment with the Speech Therapist, feels it would be useful to rule out anything neurological (i.e. coming from your throat muscles). Sometimes, they may not even know that such thing as an Achalasia exists.
Achalasia can only be ruled out by way of instrumental examination, and this is normally conducted by a Gastronenterologist. The best way to diagnose an Achalasia is to either have a barium swallow or an endoscopy. If an endoscopy was chosen as the method of investigation, they wouldn't be able to reach through to the stomach but they would be able to see the narrowing from the top/mid portion of the oesophagus.
Some of the symptoms you may have reported to your GP include:
Chest pain when eating
Coughing when eating due to food coming back up to your voicebox/windpipe area
Regurgitation or vomiting of meals and sometimes fluids
Weight loss due to not being able to eat enough calories
Feeling as if food is stuck in your throat/food pipe
Why is a swallow assessment important?
Something very important to note is how pertinent it is to get a referral either to a Speech Therapist, or to a Gastroenterologist. Sometimes people will be prescribed/suggested to have thickened fluids because the individual is coughing when eating/drinking. This can be very dangerous for the person involved as it can increase the amount of regurgitation, which can increase the chance of substances entering the windpipe. When foreign substances enter the airways, this can sometimes cause pneumonia. Pneumonia can be life threatening for some people.
Hence, this is why a good Speech Therapist knows that "thickened is not always best", and why a swallowing referral is important. As a Speech Therapist, we often refrain from encouraging Nurses, GP's and others to suggest thickened fluids without a prior referral, for this very reason.
After the Swallow Assessment
Following a full swallow assessment, if a Speech Therapist suspects an Achalasia or any other oesophageal dysfunction, they will refer you straight back to your GP, with a suggestion that you get seen by a Gastroenterologist. Whilst awaiting further formal assessment, the Speech Therapist may suggest that you try puree/blended food or very thin, sloppy food, as it is likely that this could be the only thing that can get through to your stomach. Normal or thin fluids may also be able to get through. This will only apply if you haven't already worked out a food texture that is best for you to swallow.
Disclaimer. Individuals should seek medical or qualified practitioners advice if any of the above symptoms are noted. This blog is not a source of treatment and individuals should not diagnose themselves, based on the above information.