Achalasia

Achalasia is a motility disorder that affects muscle function when the nerves in the esophagus degenerate. As a result, the muscles in the esophagus stop working, and the valve at the bottom of the esophagus does not open.

Normally when a person swallows, a reflex relaxes the lower esophageal sphincter and the esophagus muscles begin to move food toward digestion. The esophageal sphincter is a valve at the bottom of the esophagus that opens and allows contents to drain into the stomach. If a patient has achalasia, the lower esophageal sphincter does not open appropriately and the body of the esophagus does not squeeze food down in a coordinated way, leading to regurgitation and inability to empty contents into the stomach.

Achalasia is a relatively rare condition, affecting about 3,000 people in the U.S. annually, and can strike anyone at any age. Achalasia can dramatically affect a person’s quality of life by making it difficult to eat, disrupting sleep due to regurgitation, and may cause substantial weight loss.

Achalasia Symptoms

The primary symptoms of achalasia are:

  • Dysphagia (difficulty swallowing solid foods and liquids)
  • Regurgitation (effortless movement of food contents up the chest) worsened by lying down
  • Chest pain
  • Weight loss
  • Recurrent pneumonia

Achalasia is easiest to treat when identified early. A physician should make a diagnosis since many other conditions have the same symptoms as achalasia. It is important to contact a physician if you have difficulty swallowing, keeping food down or if you are experiencing unintended weight loss.

Diagnosing Achalasia

The main diagnostic test for achalasia is high-resolution esophageal manometry, which measures the movement and pressures in the esophagus. In this procedure, a thin catheter passes through the nose and into the esophagus. While the patient takes sips of water, the pressures and coordination of the esophagus are measured.

Other diagnostic tools used to evaluate achalasia and exclude other conditions include:

 

Achalasia Treatment Options

Most patients are treated with pneumatic balloon dilation or Heller myotomy. The choice between these two procedures depends on the individual’s specific type of achalasia and personal preference. Experts from gastrointestinal specialties, thoracic surgery, minimally invasive surgery and radiology work together and make recommendations for management of each patient’s condition.

While there is no cure for achalasia, various medications or surgical procedures can alleviate and treat the symptoms. Your doctor may recommend treatments and minimally invasive procedures such as:

  • Pneumatic balloon dilation: In this procedure, a balloon or rubber dilator is used with esophagoscopy to stretch the muscles of the lower esophageal sphincter. 
  • Injection of botulinum toxin (Botox): Injection of Botox with esophagoscopy may be used to relax the lower esophageal sphincter with lasting effects of 1-2 months.
  • Heller myotomy with fundoplasty: This minimally invasive procedure involves altering muscles in the esophagus and stomach to allow easier passage of food and prevent severe GERD symptoms. Optionally, a myotomy can be performed through an open incision in the abdomen or the left side of the chest between the ribs.
  • Peroral endoscopic myotomy (POEM): A minimally invasive procedure, a POEM is performed at the time of an upper endoscopy. A scope passes through the mouth to the inside lining of the esophagus. Altering muscles of the lower esophageal sphincter allows for easier passage of food without any incisions through the skin. 
  • Esophagectomy: For patients experiencing severe symptoms such as severe dilation or tortuous esophagus, removal of the esophagus, or esophagectomy, may be recommended. This procedure removes and replaces a portion or the entire length of the esophagus to restore comfortable swallowing.

Typically, minimally invasive (laparoscopic) surgery requires a hospital stay of 24-48 hours following the procedure. You likely will be able to return to regular activities in about 2 weeks. With open surgery, your hospital stay may be slightly longer, but you should still be able to return to normal activities in 2 to 4 weeks. Patients will generally go home on a liquid diet for a few days slowly progressing to a soft diet for a few weeks. 

Research for Achalasia

The University of Michigan Esophageal Disorders Program dedicates part of its research efforts to improving diagnosis and management of achalasia. Contact us to find out about current clinical studies that may be available.

Other Information About Digestive and Liver Health

To see related medical services we offer, visit our Digestive and Liver Health overview page. 

Make an Appointment

Our multidisciplinary team includes experts in minimally invasive surgery, thoracic surgery, radiology, and pathology. To schedule an appointment to discuss your need for treatment of Achalasia, call us at 888-229-7408.