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Achalasia


Achalasia is a rare condition that makes it hard for the esophagus to move food into the stomach. A loss of nerve cells in the esophagus causes achalasia, but the reason for this loss is unknown.

The esophagus is a muscular tube that connects your throat to your stomach. This swallowing tube uses waves of muscle contractions to push food or drinks down into the stomach. At the bottom of the esophagus is a muscular valve called the lower esophageal sphincter (LES). When you eat or drink, the LES relaxes to allow food to enter the stomach and then contracts to keep the stomach’s contents from washing back up into the esophagus.

In people with achalasia, the muscles of the esophagus don’t work correctly:

  • The LES does not completely relax, so food cannot pass into the stomach.
  • The muscles of the esophagus are weak and do not push food into the stomach as they should.

As time passes, the esophagus becomes more dilated (widened), making it harder to swallow food and fluid. Achalasia can lead to other problems, such as:

  • Aspiration pneumonia, a lung infection that can be caused by breathing in regurgitated food or liquids
  • Esophageal cancer (rare).

Symptoms 

Achalasia may cause the following symptoms:

  • Difficulty swallowing food and liquids (dysphagia)
  • Food and liquids coming back up your esophagus and into your throat (regurgitation)
  • Chest pain that may be worse during or after eating
  • Waking up at night because of coughing or choking on regurgitated food
  • Heartburn-like symptoms
  • Unintentional weight loss
  • Repeated bouts of pneumonia.

You should not ignore these symptoms.

Diagnosis

At Norton Thoracic Institute (NTI), your doctor may use one or more of the following tests to determine if you have achalasia:

  • Manometry to measure how strong and coordinated the muscles of your esophagus are and to see whether the LES is working properly. In this test, a thin tube is passed through your mouth or nose into your esophagus, and measurements are taken as you swallow small amounts of water.
  • Upper endoscopy to examine the inside of your esophagus, LES, and stomach. In this procedure, a flexible tube (endoscope) with a light and camera is passed into your esophagus while you are lightly sedated.
  • Barium swallow to look for signs of achalasia, such as a widened esophagus or a tight LES. During this exam, you swallow a thick liquid called barium and undergo an x-ray. The barium allows the physician to view the outline of the esophagus and LES more clearly.

Treatment

The team of experts at NTI offers several treatments for achalasia. The goal of these treatments is to allow food and liquid to pass more easily into the stomach. 

  • Botox injection into the LES paralyzes the muscles of the LES, relaxing them and helping food enter your stomach. Botox injection gives temporary relief.
  • Myotomy is a surgical procedure during which the surgeon cuts the muscles of the LES. Myotomy usually gives long-term relief from the symptoms of achalasia. 
  • Heller myotomy/Dor fundoplication is a laparoscopic procedure done through five small incisions in the abdomen. The doctor inserts a viewing tube and tiny surgical instruments through the incisions, and then cuts some of the muscles of the LES to allow food to move more easily into the stomach. Most patients who undergo this surgery stay in the hospital overnight. 
  • Balloon dilatation is an outpatient procedure to widen the LES. The doctor uses an endoscope to inflate a small balloon in your LES to expand it and allow food to pass.

Prevention

You cannot prevent achalasia, but you can take steps to help control your symptoms.

  • Don’t smoke.
  • Drink plenty of fluid when you eat.
  • Choose soft foods or liquids, if necessary.
  • Chew your food well, and eat smaller, more frequent meals.
  • Do not eat within three hours of your bedtime.
  • Elevate the head of your bed.

Learn More About Achalasia Services at Norton Thoracic Institute

To learn more about the achalasia services at Norton Thoracic Institute, call 602.406.4000.