Achalasia is a disorder of the esophagus that makes it difficult to swallow solid or liquid foods. About 70 percent of patients with achalasia also experience regurgitation (backflow) of food. Heartburn and chest pain also may be present with achalasia. Although it can develop in children and adults, this condition occurs most often in middle-age adults or older adults. The condition occurs when the esophageal sphincter muscle (located between the esophagus and the stomach) doesn’t relax as much as it should, which makes it hard for food to pass from the esophagus into the stomach. The etiology of this disease is not known.
Achalasia is a rare disorder–only about 2,000 people in the U.S. are diagnosed each year. Because the condition is so rare, it’s helpful to choose a surgeon with experience in diagnosing and treating this disorder and other problems of the esophagus. Our surgeons specialize in the surgical management of achalasia and other foregut procedures.
Achalasia is one type of several different esophageal motility disorders. The most frequent symptom of achalasia is difficulty swallowing. This difficulty may last months or even years before a person seeks help. Other symptoms include:
- Regurgitation of food
- Chest pain after eating
- Weight loss
Diagnostic Tests Define the Problem Proper diagnosis is the first step toward appropriate and effective treatment. Physicians at the University of Chicago may recommend any of several tests to determine the exact nature of the problem and to rule out the presence of esophageal cancer. Diagnostic testing may include:
X-ray of the chest and upper GI (gastrointestinal/digestive system) tract
Endoscopy. Insertion of a thin, flexible tube down the throat, through the esophagus and into the stomach. The endoscope is equipped with a tiny camera that enables the physician to actually see inside the esophagus and other organs. This test is important to make sure cancer is not present.
Manometry. This is a test that measures the strength and coordination of the muscles in the esophagus. For this test, a very thin tube is passed through the nose and down to the stomach. The test then measures esophageal muscle function while the patient swallows sips of water. Manometry also evaluates the function and relaxation of the valve (lower esophageal sphincter) located between the esophagus and stomach.
A surgical procedure called laparoscopic esophageal myotomy (cutting of the esophageal muscle) can decrease the pressure of the lower esophageal sphincter muscle and make it easier to swallow.
Laparoscopic esophageal myotomy is a minimally invasive surgical procedure performed through five small incisions. The surgeon cuts the muscles of the sphincter located between the esophagus and stomach (LES), which makes it easier for food to pass through. Compared to traditional myotomy surgery (done through a large incision in the abdomen or side of the chest), patients undergoing laparoscopic myotomy experience faster and easier recovery with much less pain. After the laparoscopic procedure, patients usually only need one night in the hospital, and then can recover at home. Patients usually leave the hospital the first day after the operation.
Achalasia can be treated with dilation of the lower esophageal sphincter or by injecting Botox (botulinum toxin) into the esophagus to temporarily relax the sphincter. Both of these are only temporary solutions, and the only permanent solution is surgery.
Oral medications are not effective for treating achalasia.