Achalasia is a motility problem of the esophagus where the lower esophageal sphincter (LES), a valve located at the end of the esophagus, stays closed during swallowing. This leads to gradual development of food dysphagia more often to solids than liquids. Achalasia devlops roughly in 4000 people in the United States and typically occurs in young adults.
Patietns with achalasia are unable to eat solid food properly but may tolerate liquids well. Gradually as the disease progress, they develop difficulty swallowing liquid as well. Due to the distal obstruction, the proximal esophagus dilates gradually and may become dilated and tortous. This leads to foul breath ( halitosis), regurgitation of undigested food and possibly aspiration pneumonia. The cause of achlasia where eshopahgeal muscles fail to contract normally is largely unknown. Many researchers believe that achalasia may be linked to virus or to patients own immune system.
Some of the common test done to diagnose Achalasia includes barium swallow, endoscopy and manometry.In barium swallow, the patient will swallow a liquid contrast material the X-ray is taken during the act of swallowing. They typical x-ray finding for barium study will include bird’s beak appearance. Endoscopy will show dilated esophagus with retained food and narrow distal.esophagus. Manometry is a study where a pressure sensor probe is placed in esophagus and squeeze pressure of esophagus is recorded during the act of swallowing.
dilation : You can have short term relief of symptoms by a procedure called dilation. Under sedation, your gastroenterologist will dilate the lower esophageal sphincter using a balloon which will widen the narrow gastro esophageal opening. You may have to undergo repeated dilation treatments in order to achieve symptom improvement, and the dilations may have to be repeated every few months to years to ensure long-term results.
heller myotomy and anterior fundoplication. Through an operation, called Heller myotomy you can expect a long term symptoms relief. The operation involved splitting of the muscles of the lower esophagus which allows the esophagus open in the stomach when you swallow the food. At St. joseph hosptial, we perform this operation using Single site Laparsocopy. Where only a small incision is made in the umbilicus. Traditional laparoscopy involves multiple ports whereas, at our advanced laparoscopy program, we are able to accomplish the operation with a single laparoscopic port. We routinely perform anterior fundoplication to cover the muscle split with the fundus of the stomach.
Treatment of achalasia consist of treatment of symptoms. The symptoms are relieved by relieving the distal esophageal pressure which is the cause of the dysphagia. Several treatment options are available including
Botox injection : Many patients can have short term relief of the symptoms of achalasia by injecting a small dose of Botox® (botulinum toxin) injection in the lower esophageal sphincter through endoscopy. This leads to relaxation of the sphincter. The injections may be repeated frequently in order to achieve symptom relief. Some other oral medications that can be taken include nifedipine and nitroglycerin which may help to relax spastic esophageal muscles.
You can expect to stay overnight for your recovery. We typically will start you on liquid diet immediately after your operation. You will be discharge once you tolerate your diet. At your discharge, you will be given a complete discharge instruction, pain medication prescription and contact information in case of any post operative issues. We will see you back in our office for post operative check up in 5-7 days.
A few complication that are associated with this procedure include but not limited are esophageal leak Wound infection,Bleeding,Pneumonia, General Anesthesia complications.