Achalasia (Swallowing disorder) What is achalasia?

Patients typically experience this disorder as a difficulty swallowing foods and liquids. Achalasia is a fairly rare disorder of the smooth muscle of the esophagus, the food pipe leading from the mouth to the stomach.

Where the esophagus meets the stomach is a ring-like “gateway” muscle called the lower esophageal sphincter (LES). When you’re not swallowing, the LES stays closed to keep the food, liquids and digestive acids in the stomach from flowing back up into the esophagus. When you do swallow, nerve signals tell the muscles of the esophagus to contract and push food down its tube (an action called peristalsis); and these same signals tell the LES to open.

In patients with achalasia, the nerve cells in the lower esophageal tube and the LES don’t work properly. Two problems result: a lack of peristalsis (the waves of muscular contraction that push food down your esophagus); and the LES (the “gateway” to your stomach) doesn’t open fully.

What are the symptoms of achalasia?

Symptoms tend to start out mild, then worsen over months or years. The main symptom is difficulty swallowing solids, and, as the disorder advances, problems swallowing liquids as well. Between 70 and 97 percent of patients with achalasia have trouble swallowing both solids and liquids.

Other symptoms may include:

  • Discomfort or pain in the chest. You’ll feel it under the breastbone, especially after meals
  • Coughing, especially when lying down
  • Heartburn
  • Weight loss (over time)
  • Vomiting. If this occurs during sleep, you can inhale food particles or liquid into the lungs. This can lead to aspiration pneumonia and other respiratory infections.
What are the risk factors of achalasia?

Since the cause of achalasia isn’t known, doctors can’t pinpoint what increases the chances of getting this disease.

What tests can I expect?
  • Manometry: The doctor inserts a tube down the throat to test the pressure in the esophagus and stomach when you swallow.

  • Esophagram: X-rays are taken of the esophagus after you swallow barium, a thick liquid that creates contrast on X-rays.

  • Upper gastrointestinal endoscopy: By feeding a lighted tube carrying a mini-camera through the mouth and down the esophagus, the doctor examines the entire length of the esophagus.

What are my treatment options?
MINIMALLY INVASIVE TECHNIQUES

The goal of surgery is to make it easier for the LES to open.

Dor or Toupet partial fundoplication
Fundoplication is a procedure in which the upper part of the stomach (the fundus) is wrapped around the bottom end of the esophagus and stitched in place. This reinforces the lower esophageal sphincter's ability to close. In a Dor fundoplication, the top of the stomach is partially wrapped around the front of the esophagus’ lower end; while in a Toupet fundoplication, the top of the stomach is partially wrapped around the back of the lower esophagus.

Laparoscopic Heller myotomy
Small incisions are made in the lower esophageal sphincter (LES) to help it relax.

Balloon dilation
This treatment stretches the LES muscle using an inserted balloon, which is inflated upon reaching the narrowed spot in the esophagus.

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