Achalasia

What is achalasia?

Achalasia is caused by nerve fiber damage in your esophagus. It’s not clear why this nerve damage happens.

The lower esophageal sphincter (LES, a valve at the lower end of your esophagus) opens as you swallow to allow food into your stomach, then closes again. Lost nerve function caused by achalasia means your esophagus can’t push, and the LES can’t relax like it should. As a result, the LES doesn’t open fully, and your esophagus can’t empty properly.

Achalasia is a lifelong disorder with no cure. It can happen to anyone but is most common in middle age. Achalasia symptoms include dysphagia (difficulty swallowing) and chest pain. Regurgitation, where food or fluid that never entered your stomach comes back up, is a common problem with achalasia. You might also experience heartburn.

How is achalasia diagnosed?

Your symptoms might indicate you have achalasia. Signs of the condition can be visible during an upper GI endoscopy. This procedure involves passing an endoscope (a flexible tube fitted with a light and tiny camera) down your throat. The Institute of Esophageal and Reflux Surgery team views the images sent back by the camera on a monitor.

A barium swallow (cine esophagram) helps your doctor see any esophageal enlargement or narrowing of your LES. You swallow a barium solution that shows up on an X-ray, highlighting any abnormalities in your esophagus.

An esophageal motility study (high-resolution esophageal impedance manometry or HRIM) is one of the most accurate ways to diagnose achalasia. It involves putting a thin, flexible tube (catheter) containing pressure sensors through your nose, into your esophagus, and down to your stomach.

How is achalasia treated?

Medication and Botox® injections can help some achalasia patients. But the Institute of Esophageal and Reflux Surgery team finds that balloon dilations are the best nonsurgical approach for achalasia. During an endoscopy, your doctor passes a balloon down to the LES. They inflate the balloon, which tears the muscles in your LES, helping the LES to open more.

Surgery called a Heller myotomy is the most successful long-term treatment for achalasia. The procedure involves using minimally invasive laparoscopic techniques (small incisions in your abdomen) to cut the LES muscle. Your surgeon then rebuilds the valve to prevent acid reflux.

An alternative is per oral endoscopic myotomy (POEM). In this procedure, your doctor accesses your LES through your esophagus to make the repairs.

Call the Institute of Esophageal and Reflux Surgery today or book an appointment online for expert treatment of achalasia.