What is Achalasia?

Achalasia is a rare swallowing disorder characterized by two problems with the esophagus. The first is a lack of peristalsis, which is the involuntary process of propelling food from your mouth to your stomach. The second is a failure of the lower esophageal sphincter (LES) to relax. Achalasia literally means "failure to relax." It occurs mostly in men and women between the ages of 25 and 60, and affects both sexes equally. The incidence of achalasia is about 1 in 100,000 people a year.

Treatment of achalasia requires an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.

What are the Symptoms of Achalasia?

Symptoms may include:

  • Difficulty swallowing
  • Regurgitation
  • Weight loss
  • Chest pain
  • Hiccups or difficulty burping
  • Weight loss

What are the Causes?

The causes of achalasia are not fully understood.

How is Achalasia Diagnosed?

Diagnosis is usually made as a result of one or more of the following tests:

  • Endoscopy
    You will receive an intravenous sedative and pain medication. Once comfortable, the physician will then examine the area using an endoscope—a lighted tube with a small camera at the end. The physician will be able to view any abnormalities and take a tissue samples (biopsies) if necessary.

  • Esophageal Manometry
    This test measures the pressure inside the lower esophageal sphincter (LES). A thin tube is inserted through your mouth or nose and into your stomach. Once it is in place, the physician will gently pull the tube back into the esophagus and ask you to swallow. As you do so, the pressure and coordination of your muscle contractions will be measured. If the pressure is low or the LES is not relaxing properly, achalasia may be present. If the pressure is low or the LES is not contracting properly, it may indicate GERD (reflux disease).

  • Esophagram
    An esophagram, or contrast esophagram (also called a barium swallow), is a series of x-rays of your esophagus. For an esophagram, you will be asked to drink a barium sulfate liquid while x-rays are taken of the swallowing process. As the liquid moves from the mouth down to the esophagus, the physician can assess any narrowing, enlargement or abnormalities. You will most likely be asked not to eat or drink for 8 to 10 hours prior to the test.

How is Achalasia Treated?

Achalasia can be treated surgically and non-surgically. Neither technique is able to completely cure the condition, but both have the ability to improve symptoms.

  • Medication
    Specifically with nitrates and calcium channel blockers—is sometimes able to relax the lower esophageal sphincter (LES) muscles enough to ease achalasia. Recent research has suggested that injections of botulinum toxin (Botox) can also relax the LES by temporarily paralyzing the hyperactive cells that cause contraction.
  • Pneumatic (balloon) Dilation
    Used in patients with Barrett's Esophagus, pneumatic dilation is the placement of a specialized balloon into the esophagus and then inflating it to create a larger opening in the esophagus.

  • Myotomy
    Treatment options for esophageal conditions vary, but one of the most effective long-term therapies is myotomy, which is a generic term for surgery in which a muscle is cut. In esophageal conditions, the surgeon typically cuts the muscle fibers in the lower esophageal sphincter, or LES, to correct the condition.

There are three ways to perform a myotomy:

  • Open surgery, by means of thoracotomy or incision. When used to treat achalasia, this is called a Heller myotomy.
  • Laparoscopically, through tiny incisions in the abdomen. A thin, lighted tube called a laparoscope, and other surgical tools, are inserted through the incisions to allow the surgeon to work on the esophagus.
  • Robotic myotomy, when a surgeon guides robotic instruments in the abdomen using a computer console. The surgeon's natural hand movements are conveyed to the robotic instruments, which mimic the same movements that would be used if larger incisions, big enough for the surgeons hands, were used. Boston Medical Center was the first center in New England to perform thoracic procedures—such as Heller myotomy—using robotics.