Achalasia is a rare, chronic disorder of the esophagus that affects approximately 1 in every 100,000 people. The cause of achalasia is unknown, but recent studies suggest that it may be caused by an autoimmune disorder.
Achalasia causes the nerves in the esophagus to slowly deteriorate, which stops the muscle in the lower part of your esophagus, known as the lower esophageal sphincter (LES), from opening (relaxing) and closing (tightening) like it should. As food moves down the esophagus it is unable to enter the stomach, causing food to back up into the esophagus.
Achalasia Symptoms
Achalasia symptoms progress over time and can be confused with gastroesophageal reflux disease (GERD) symptoms. They may include:
- Difficulty swallowing
- Regurgitation
- Chest pain
- Heartburn
- Cough at night or when lying down
- Weight loss
Achalasia Diagnosis
Achalasia can be difficult to diagnose, especially when symptoms are mild or mimic gastroesophageal reflex disease or a hiatal hernia. Your doctor may order several diagnostic tests including:
- Barium swallow: A barium preparation drink which coats the esophagus and allows narrowing of the esophagus to be viewable on x-ray.
- Esophageal manometry: Considered the gold stand for achalasia testing, this test measures muscle strength and movement of the esophagus via a thin tube that is inserted through the nose.
- Upper endoscopy. In this test, a flexible, thin camera is inserted down the throat and allows doctors to view the inside of the esophagus to assess for achalasia and rule out cancer.
Achalasia Treatment
Achalasia is a lifelong condition with no cure, but there are non-surgical and surgical treatments available to help with the management of the symptoms. Your doctor will discuss these options with you to determine the best course of treatment based on the severity of your condition and personal preferences.
Achalasia treatment options include:
- Botox Injections: Botox injections can help control symptoms by blocking the nerve signals that tell the esophageal muscles to contract. The improvement is temporary and could cause scarring that makes definitive surgery more difficult, especially if done multiple times.
- Balloon Dilation: A non-surgical procedure that inflates a balloon in the lower esophageal sphincter to relax the muscle and allow food to enter the stomach. This has very limited long term improvement and can also cause scarring around the gastroesophageal junction.
- Robotic or Laparoscopic Heller Myotomy: A minimally invasive surgery that cuts the muscle fibers of the lower esophageal sphincter to improve the esophageal emptying into the stomach. Often, doctors will also perform a partial fundoplication to help prevent acid reflux, which is a common side effect of this procedure.
Because the treatments available for achalasia only treat the symptoms, long-term follow up with your doctor is necessary. Symptoms may reoccur or complications from treatment may arise.
For more information on achalasia, or to schedule an appointment with one of our board-certified general surgeons, book an appointment online or call 512-467-7151. For the latest Austin Surgeons news, follow us on Facebook and Instagram.