Achalasia is a rare esophageal disorder that prevents the esophagus from emptying properly. It makes swallowing difficult and impedes your ability to pass food and liquid from your esophagus to your stomach. Achalasia is the result of damaged nerve fibers in the esophagus.
Typically, when a person eats or drinks something, the food moves down their esophagus with the assistance of peristalsis. Peristalsis is the wavelike muscle movement of the esophagus. These muscles contract and relax in such a way that the food can travel down the esophagus with ease. Then, the food passes through the Lower Esophageal Sphincter (LES) and into the stomach. The LES is the muscle in between the stomach and the esophagus, and it serves as a barrier and a valve between the two. It opens to allow food and liquid to pass, and then contracts and closes.
However, in patients with Achalasia both peristalsis and the LES do not function properly. Achalasia can be thought of as the anatomical opposite to GERD (gastroesophageal reflux disease). Patients with GERD suffer from a weakened LES that does not close properly, while patients with Achalasia have an overly tight LES that does not open properly.
Symptoms & Diagnosis
The symptoms of achalasia can be quite uncomfortable and painful. The most prominent symptom is dysphagia, or difficulty swallowing. However, many patients also experience chest pain, regurgitation, heartburn, and weight loss. The dysphagia tends to get worse over time and become more painful, and the chest pain associated with achalasia is very acute and in some cases can be mistaken for a heart attack. According to Dr. Rolando Sanchez, “Achalasia can also lead to aspiration, which is when undigested food is breathed into the lungs.” This can be a very serious condition and may require immediate medical attention.
Diagnosis of achalasia is usually made after the administration of two tests: a barium swallow, and an esophageal motility study. The barium swallow, or cine esophagram, is a test in which a patient swallows a barium solution that is then monitored using fluoroscopy. This test evaluates the degree of esophageal distension and narrowing of the LES. The esophageal motility study measures a patient’s esophageal muscle movement and pressure. This will allow the physician to study the abnormal peristalsis and LES contractions.
Treatment & Heller Myotomy
There are a few treatment options for patients who have achalasia. Medication is sometimes used to treat it, however it is often ineffective and the medication would need to be taken for life in order to manage symptoms. Balloon dilation is another treatment method, and it is typically considered the best non-surgical option. In this procedure a balloon is used to partially tear and weaken the lower esophageal sphincter. Balloon dilation provides relief from symptoms for a decent amount of time; however, it is not a long-term solution.
The best long-term solution for treating achalasia is a surgical procedure known as a Heller Myotomy. The Heller Myotomy is a laparoscopic surgical procedure in which the muscles of the lower esophageal sphincter are cut and then partially rebuilt. This procedure will allow for food and liquid to pass through the LES much easier and is the best long-term solution for achalasia. The LES is reconstructed during the procedure to prevent the patient from suffering from GERD, which occur if the LES was too loose.
Living with achalasia can be difficult, but there are treatment options available for patients suffering from the condition. If you’re struggling with achalasia and live in the Tampa, Brandon, St. Petersburg, or Riverview areas, schedule a consult with our specialists to discuss your options!