Achalasia

What Is Achalasia?

Achalasia is an uncommon motility disorder of the esophagus (swallowing tube). It can cause difficulty in swallowing, regurgitation after meals, weight loss and chest pain. The exact cause of achalasia is unknown. It is a neurological problem of the esophagus, where the muscle at the end of the esophagus, the lower esophageal sphincter (LES), does not relax enough for food to pass properly. Hence, ingested foods get stuck in the esophagus.

How do you diagnosis achalasia?

Achalasia can be diagnosed only by esophageal manometry. However, tests such as upper endoscopy or an x-ray of the esophagus can suggest achalasia.

What are the treatment options for achalasia?

Achalasia can be treated in several different ways. Therapy is selected for each individual based on many factors, such as age, the severity of achalasia and co-existing medical problems. Therapy options include:

Medicines

Achalasia may be treated with certain medications, however the results are usually temporary if the patient responds at all. These medications include nitrates (nitroglycerine underneath the tongue) or calcium channel blockers.

Botox Injections

Botulim toxin (Botox) can be injected directly into the lower esophageal sphincter muscle during an upper endoscopy. The Botox paralyzes the muscle so it stops contracting, hence relaxing the muscle. This is a safe procedure and can be effective in many patients, especially older patients who are not good candidates for surgery. However, the benefit of Botox is usually temporary and requires further injections.

Endoscopic balloon dilation

The lower esophageal sphincter (LES) can be stretched with a balloon, usually 3 cm or 3.5 cm in diameter. This procedure can be performed through an upper endoscopy without surgery. It can be effective in up to 80 to 85% of patients. However, there is a risk of causing a tear in the esophagus requiring surgery to repair it.

Surgery (Heller Myotomy)

The lower esophagus muscle can be cut during an operation to cause relaxation of the lower esophageal sphincter. This can be an affective treatment for achalasia, especially for those patients who are good surgical candidates. This surgery can now be performed using minimal invasive technique to minimize pain and hospital stay.

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