What is Esophageal Achalasia?
Achalasia is a condition that effects the esophagus, or swallowing tube. It is characterized by excessive tightness of the circular muscle that guards the opening between the esophagus and the stomach. The muscle is unable to relax during swallowing to allow food to pass into the stomach as easily as it normally does. The cause of achalasia is unknown. There is some evidence to suggest that it is related to a localized degeneration of the nerve cells within the wall of the esophagus.
Symptoms of Achalasia
Patients with achalasia often complain of having one or more of the following:
- Difficulty swallowing, especially cold foods
- Regurgitation of undigested food
- Pain in the middle of the chest
- Coughing or choking, especially when lying down
- Chronic bronchitis, laryngitis, or pneumonia
The condition generally worsens over time and can lead to weight loss and difficulty maintaining normal nutrition. Achalasia can also lead to chronic lung infections due to food and fluid backing up into the windpipe.
Testing for Achalasia
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Achalasia is generally diagnosed either with an Upper GI X-ray or an endoscopy. The classic appearance is a dilated esophagus that quickly narrows to a very tight area just above the stomach. It is also possible to diagnose achalasia using a test called esophageal motility. This test measures the actual pressures within the esophagus, which are very high in the area of narrowing, and very low in the rest of the esophagus.
Once the diagnosis of achalasia is made there are two non-surgical treatments that may be tried:
* The lower esophagus can be dilated, which literally stretches the narrow opening. Relief is usually temporary,
and each dilation carries with it the risk of rupturing the esophagus.
* Botox injections directly into the esophagus can actually relax the muscle somewhat, providing temporary
improvement. Repeated injections generally are less effective than the initial treatment.
Minimally Invasive Treatment Options
The operation that is typically used to treat achalasia is called a laparoscopic Heller myotomy. During this procedure the muscle between the esophagus and the stomach is surgically split, creating a larger opening. Following this procedure most patients enjoy long-term relief of their symptoms. The laparoscopic technique makes the procedure far less painful and the recovery is much shorter than with conventional open surgery. Following Heller myotomy some patients develop symptoms of acid reflux since the valve is now wide open. To reduce this risk a partial fundoplication is generally performed along with the Heller myotomy. Even so, some patients may need to take acid reducing medications after surgery, such as proton pump inhibitors, to control symptoms of heartburn. Following surgery your diet will be restricted for a few weeks to allow the area to heal and the swelling to resolve. Click HERE to view the post-operative diet instructions.