Achalasia

Things to Know About Achalasia

Achalasia is a rare medical disorder where it is challenging for liquid and food to pass through your esophagus into your stomach. In this disorder the muscles of the esophagus stop working properly making it difficult to squeeze food down and pass it into the stomach. The valve between the stomach and esophagus does not relax properly in achalasia so food may be get stuck in the esophagus.

What are the symptoms of Achalasia?

Some of the common symptoms associated with achalasia include:

1. Dysphagia – feeling solid food or liquids getting stuck in the throat or chest
2. Regurgitation – spitting up of liquid or solid contents after drinking/eating. This may happen more commonly at night time when you are laying down
3. Chest pain
4. Weight loss

How is Achalasia Diagnosed?

Many of the symptoms associated with achalasia may be similar to other disorders. As such, your doctor will want to do some testing to determine what disorder you might have.

• Esophageal Manometry – This is the gold standard test for diagnosis of achalasia. It will measure the muscle contractions made by the esophagus as you swallow. It will also look at the force that the esophagus muscles exert and how well the lower esophagus relaxes while swallowing.
• X-Rays of Upper Digestive – With an X-ray, your doctor will ask you to consume a chalk-like liquid that will coat and fill the lining of your digestive tract. This lets the doctor see a picture of your upper intestine, stomach, and esophagus. In some cases, you may also be asked to swallow a barium pill, which assists in showing if there is a blockage in the esophagus.
• Upper Endoscopy (EGD  If your doctor does an endoscopy, this involves placing a thin tube, with a camera and light, down your throat. This allows the physician to examine your stomach and esophagus. This can show if there is a blockage in the esophagus, as well.

How is Achalasia Treated?

Treatment for achalasia focuses reducing the contraction or pressure at the lower sphincter of the esophagus (LES) so that liquids and food can more easily move into your stomach. There are surgical and non-surgical treatment options to achieve this.

Medical Treatment Options

There are medications that might relax the muscle at the LES, which included nifedipine or nitroglycerin.  They are typically only able to offer limited relief and can have side effects. These are usually if the patient is not a good candidate for more interventional or definitive therapies.

One treatment that is nonsurgical is pneumatic dilation. With this procedure, your doctor will insert a balloon into the esophagus and then inflate the balloon to make the opening larger. This procedure may be required to be repeated if the esophageal sphincter doesn’t stay at that size. About one in three patients will need repeat treatment within six years of the first treatment.

Endoscopic Treatment Options

Endoscopic therapy for achalasia has been shown to be highly effective.  There are various techniques that can be performed and the advantage is that these a minimally invasive procedures without any surgery or significant recovery time.

One endoscopic therapy that has been performed is botox injection (also known as botulinum toxin type A). This is a muscle relaxant that can be injected into the LES with the assistance of an endoscope.  This therapy has been shown to work for a limited amount of time and has a concerning side effect of causing significant scarring of the LES.  Botox injection at the LES has fallen out of favor significantly because it can make other more definitive therapies very difficult to perform. For this reason we try to avoid this type of endoscopic therapy.

Another endoscopic therapy that is effective and quite useful is the pneumatic dilation.  This involves placing a balloon across the LES with the assistance of an endoscope and inflating it to dilate, stretch and even tear the LES to weaken the muscle.  Pneumatic dilation has been shown to be very effective for achalasia patients, but may require repeated therapies over time to maintain its effect.

Finally the most popular endoscopic technique available now is the POEM (peroral endoscopic myotomy) procedure.  This is an novel, exciting technique that uses modern technologic instruments endoscopists to perform cutting of the muscle of the LES completely from within the body using an endoscope.  POEM has been shown to be as effective as surgery, safe, and with very short recovery times.  Generally patients need to stay in the hospital only one night after a POEM procedure.

Surgical Treatment Options

Surgery has been the conventional standard for therapy for achalasia patients – to cut the muscles of the LES.  However this is now changing with the advent of the POEM procedure.

The surgical procedure that is performed is called the Heller myotomy, which involves cutting the end of the esophageal sphincter, so food can more easily pass. This procedure is usually performed along with a Dor fundoplication, which consists of a surgeon wrapping the part of the top of the stomach around the esophageal sphincter. This procedure involves a cardiothoracic surgeon dissecting through the skin to the level of the LES to perform intervention.

Treating Achalasia in Dallas & Fort Worth, Tx

Are you interested in learning more about achalasia, or other GI conditions? We invite you to contact us to learn more. Dr. Prashant Kedia is a therapeutic endoscopist and gastroenterologist serving patients in the Dallas-Fort Worth area and beyond. Call today to schedule an appointment at (214) 941-6891.

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