Achalasia is a rare disorder of the esophagus, where affected individuals are unable to push down food from the throat to the stomach effectively after swallowing. This disorder affects about one in every 100,000 people in the United States.

Despite its rarity, achalasia is well known to our surgeons. They offer patients the latest knowledge and expertise when it comes to diagnosing and treating achalasia.

Achalasia’s Impact and Diagnosis

Achalasia causes the nerves in the esophagus to degenerate, which leads to two significant problems.

  1. The esophagus does not squeeze food or fluids down effectively when a person swallows.
     
  2. The sphincter, or valve, at the bottom of the esophagus stays closed and does not allow food to pass through. This causes vomiting, regurgitation of fluid or food, heartburn, chest pain and weight loss due to the inability to eat.

Achalasia doesn’t happen suddenly, and individuals may live with mild to moderate symptoms for years. Often, they’re treated for reflux and have minimal improvement in their symptoms.

The best way to confirm an achalasia diagnosis is by using an esophageal manometry test, which measures the esophagus’ ability to squeeze and the ability of the lower esophageal sphincter to relax. For those who display symptoms of dysphagia (swallowing disorder) or regurgitation, an upper GI esophagram is a noninvasive way of checking for an esophageal motility (movement) disorder.

Achalasia Treatment Options

After diagnosis, patients and their providers can select from a range of treatments.

  • Injections of the lower esophageal sphincter — While these Botox injections work reasonably well, they only last a few weeks or months. They aren’t a long-term solution, as the body forms antibodies to Botox after one or two injections.
     
  • Endoscopic pneumatic dilation — This treatment mechanically expands the lower esophageal sphincter and works well, but often requires multiple sessions of stretching. Since the process needs to be repeated, long-term results are an issue. Another concern is the risk of stretching too far and perforating the esophagus.
     
  • Laparoscopic Heller myotomy — During this surgical procedure, the muscle fibers of the lower esophageal sphincter are cut. If you think of the sphincter as a circular valve, picture it being cut so it opens from a circle to a U shape. Because the Ushaped sphincter can’t constrict the bottom of the esophagus, it is able to relax and allow food to pass through to the stomach. The surgery usually requires five small incisions in the abdomen, and patients typically stay one to three nights in the hospital. More than 90% of patients who have this procedure feel significant relief of their symptoms.
     
  • Peroral endoscopic myotomy (POEM) — This less invasive approach is the latest advancement in achalasia treatment. While the patient is under general anesthesia, the sphincter is cut using an endoscope without making any incisions externally. The POEM procedure takes about 90 minutes, offering patients a quicker recovery with reduced pain. They often leave the hospital the same day or after a one-night stay.

    The POEM procedure is available at only a small number of centers in the United States, including the Froedtert & MCW health network. Patients are usually attracted to this surgery due to the lack of external incisions. Other benefits are thataccessing the valve from the inside is less risky, and there is less trauma to the body than from a traditional surgery. Following a POEM procedure, patients typically eat a soft diet for a few weeks and take an acid supplement for several months.

While none of these treatments are a cure for achalasia, the POEM procedure allows patients’ symptoms to resolve and brings back their swallowing ability. Patients who may have felt marginalized by their disorder feel more comfortable with eating in a public setting again without the fear of regurgitation or vomiting.

Importance of Seeking Treatment and Early Intervention

If left untreated, individuals with achalasia face a difficult future. The esophagus can continue to expand and develop curves. People who are not treated have a reduced response to standard treatments when they get to the final stages of achalasia, and they may even need a feeding tube to maintain nutrition. If achalasia is diagnosed, a conversation with a physician who can offer treatment options and plan further treatment is a must.

Recognized as High Performing by U.S. News & World Report

Froedtert Hospital is recognized by U.S. News & World Report as high performing in three adult specialties and 16 procedures and conditions, including gastroenterology and GI surgery.

Virtual Visits Are Available

Safe and convenient virtual visits by video let you get the care you need via a mobile device, tablet or computer wherever you are. We'll assess your condition and develop a treatment plan right away. To schedule a virtual visit, call 414-777-7700.

Learn More