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VCU Division of Cardiothoracic Surgery, Department of Surgery, Virginia Commonwealth University VCU Division of Cardiothoracic Surgery VCU Medical Center VCU

VCU Division of Cardiothoracic Surgery

Achalasia

What is Achalasia

Achalasia means failure to relax.  The function of the esophagus is to take food from the mouth to the stomach.  The muscular wall of the esophagus squeezes the food bolus down in a coordinated way and the lower esophageal sphincter (LES) relaxes at the same time to let food pass into the stomach.  In achalasia, the LES does not relax and the esophagus loses its squeeze function.

Why does one get Achalasia

The cause of achalasia is unknown.  It is thought to be of viral or auto-immune origin.  In south America, it is seen with Chagas disease, a parasytic infection.

Symptoms of Achalasia
  • Inability to pass solid and sometimes liquid food down, referred to as dysphagia
  • Regurgitation
  • Heartburn
  • Chest pain
  • Weight loss

The regurgitation and heartburn sometimes felt with achalasia are due to food and liquid regurgitation upwards from within the esophagus rather than coming up from the stomach across the lower esophageal sphincter.

Diagnosis

Figuring out one has achalasia is based on three things- patients symptoms, barium study and manometry.  All the testing is done as an outpatient.

  • In a barium study, patient drinks a liquid that shows up as white on an x-ray and it shows a dilated esophagus with a tight narrowing distally, referred to as ‘bird beak’ apprearance.
  • In manometry, a catheter is passed into the esophagus and it shows waves like EKG of the heart.  It confirms lack of squeeze in the esophagus and lack of relaxation in the LES.
Treatment

Achalasia treatment requires opening of the LES muscle to allow passage of food.  This can be accomplished by a botox injection and balloon dilation.  The benefits with these endoscopic treatments are not as long lasting as surgery.  It is commonly used to give patients relief while they await surgery and for patients deemed not to be surgical candidates.

The gold standard surgical treatment for achalasia is a minimally invasive Heller myotomy and a Dor fundoplication.  It is done via laparoscopy with minimal post-operative discomfort.

 

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