Robotic
Esophageal Surgery
Samer A.Kanaan, MD, FACS

Achalasia

What is achalasia?

Achalasia is a condition in which the esophagus (tube carrying food from the mouth to the stomach) is unable to move food into the stomach. The muscles at the lower end of the esophageal sphincter fail to relax and allow food to pass into the stomach, resulting in reflux.

What are the causes for achalasia?

Esophageal achalasia is caused by damage to the nerves supplying the esophagus, which affects:

  • Muscles lining the esophagus that rhythmically contract to push food towards the stomach
  • Muscles of the lower esophageal sphincter that act as a gate for the one-way movement of food into the stomach

The cause of damage is not clear, but may be associated with an earlier viral infection or autoimmune condition, such as lupus and uveitis, where the body attacks its own healthy cells.

What are the symptoms of achalasia?

Common symptoms of achalasia include difficulty swallowing (dysphagia) both solid and liquid foods, and experiencing the sensation of food getting stuck in the chest. To facilitate swallowing you may make changes in the way you eat. Other symptoms include regurgitation of food, heartburn, sensation of fullness and chest pain. In advanced stages of the disease, you may experience weight loss and suffer from malnutrition (although this is rare).

How is achalasia diagnosed?

Your doctor may order the following tests to diagnose achalasia:

  • Barium swallow test: involves swallowing a barium preparation, which can be detected through X-rays
  • Endoscopy: allows the doctor to examine the inside of your esophagus, stomach, and portions of the intestine, with an instrument called an endoscope, a thin flexible lighted tube
  • Manometry: measures changes in pressure exerted by the esophageal sphincter

How is achalasia treated?

Treatment goals are opening or relaxing the lower esophageal sphincter muscles for easy passage of food into the stomach. Some of the options for relieving symptoms include:

  • Medications: Medications help relax the lower esophagus sphincter muscles and provide temporary relief.
  • Botox injection: Botulinum toxin injection can be administered to help relax the sphincter muscles. It provides temporary relief only and has to be repeated after a few months or years.
  • Balloon dilation (pneumatic dilatation): A small balloon is positioned at the lower esophagus sphincter and inflated to widen the opening. Although this procedure improves swallowing, it is not a permanent solution and needs to be repeated.
  • Myotomy surgery: Myotomy is a surgical procedure in which the sphincter muscle is cut to open up the esophagus. This surgery provides a permanent solution to swallowing.