Achalasia

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This is a rare condition that affects the normal function of the lower esophageal sphincter. The lower esophageal sphincter is a muscle located at the junction of the esophagus and the stomach. When functioning normally, this muscle relaxes to allow food to enter the stomach from the esophagus.

Achalasia causes the lower esophageal sphincter to lose proper function, inhibiting it from relaxing properly. In addition, it also affects peristalsis, the normal contractual movement of the esophagus that moves food and liquid through to the stomach.

Symptoms

Symptoms of achalasia include:

Dysphagia (difficulty swallowing)
Chest pain
Unexplained weight loss
Heartburn
Regurgitation (backflow) of food and liquid

Causes

Achalasia develops as the result of nerve damage to the muscles of the esophagus and therefore degeneration of the esophageal muscles. The reasons for nerve damage are not yet well understood. Currently, scientists believe that nerve damage to the esophagus may be due to infection or an inherited condition of the immune system.

What to expect at your appointment?

During your appointment, your doctor will ask you to describe your symptoms and indicate how long you have had them. In order to make a diagnosis, your doctor may prescribe a few diagnostic procedures, including:

Manometry: An esophageal manometry measures how well the lower esophageal sphincter is working. During this procedure, a thin, flexible tube is inserted into the mouth, through the esophagus, and into the stomach. This tube is sensitive to pressure and, when the patient swallows, measures the strength of the esophageal muscles.
Upper endoscopy: An upper endoscopy is used to examine the esophagus and can help physicians identify conditions that can cause similar symptoms to achalasia. During the procedure, a thin, flexible tube with a light and a camera on the end is inserted into the mouth and through to the esophagus.

Non-surgical treatments

Treatment recommendations will be based on the severity of symptoms as well as the overall health of the patient. When appropriate, achalasia will most likely be treated using non-surgical treatments first.

Oral medications: Prescription medications can be used to help relax the muscle of the lower esophageal sphincter to help food pass into the stomach.
Botox injections: Botox injections directly into the lower esophageal sphincter can also be used. Botox relaxes the lower esophageal sphincter, allowing food and liquid to pass into the stomach. These injections are given using an endoscope, a thin, flexible tube that is passed into the esophagus through the mouth. Injections need to be administered every few months, as Botox is only active for this amount of time.
Manual dilation or widening of the esophagus: In some cases, manual dilation of the lower esophageal sphincter may be used to treat achalasia. This can be achieved by using a balloon that is lowered through the esophagus. When the balloon is inflated, it stretches the muscle and widens the opening between the esophagus and the stomach.
Changes in diet or eating habits: A specific diet may not be given to patients. However, some patients may find that certain foods pass more easily to the stomach than others. Therefore, making changes to one’s diet or eating habits may help relieve the symptoms of achalasia.

Surgical treatment for achalasia and post-treatment

If necessary, achalasia can be treated surgically using the Heller myotomy, which is a minimally invasive procedure that cuts the lower esophageal sphincter to loosen the muscle. Patients may be required to stay in the hospital for 1 to 2 days following the procedure.