Achalasia

Achalasia is an uncommon esophageal disorder that prevents normal swallowing, making it difficult for food and liquids to pass into the stomach. This happens when the muscles of the entire esophagus fail to contract and propel food into the stomach. The muscle at the bottom of the esophagus (lower esophageal sphincter or LES) also may fail to relax properly. Both contractions and an open LES are essential for moving food downward through the esophagus and into the stomach. While we can fix the opening at the bottom of the esophagus laparoscopically, we cannot revive the nerves or muscles of the esophagus, so after surgery the esophagus will empty into the stomach by gravity. We usually perform a partial plication or folding of the stomach over the esophagus where we have worked to help prevent some of the acid reflux that commonly occurs after opening the LES.

Symptoms of Achalasia

• Difficulty swallowing (Dysphagia) 
• Regurgitation 
• Choking or coughing 
• Chest pain 
• Heartburn 
• Unintentional weight loss 

How is Achalasia Diagnosed?

Dr. Vine works closely with his radiology and gastroenterology colleagues who will likely perform the following tests,

1. Esophageal Manometry – A test examining muscle movement in the esophagus to see if the lower esophageal sphincter relaxes properly.
2. Barium Swallow (Esophagram) – An X-ray test performed while a patient drinks a barium solution, allowing doctors to observe food and liquid passing through the esophagus.
3. Endoscopy (EGD – Esophagogastroduodenoscopy) – A procedure under sedation using a thin, flexible tube with a light and camera (endoscope) to examine the esophagus. stomach and intestines .
4. Esophageal pH Monitoring – A test measuring acid levels in the esophagus, often used to distinguish achalasia from Gastroesophageal Reflux Disease (GERD).
5. CT Scan or MRI – Advanced imaging used to check for abnormalities, like tumors or structural issues in the esophagus.

While the exact cause is unknown, achalasia is believed to be related to nerve damage, autoimmune conditions or genetic factors. If left untreated, it can cause severe weight loss, malnutrition, or aspiration pneumonia from food entering the lungs. There is a very similar disease in South America called Chagas disease that behaves exactly like achalasia and is caused by a parasitic infection, so travel history may be important to diagnose this condition.

Dr. Anthony Vine has performed many successful laparoscopic procedures on patients suffering from achalasia. For more on this minimally invasive procedure, visit Laparoscopic Esophageal Surgery and Heller Myotomy.