Achalasia

Achalasia can often begin subtly, with changes in swallowing happening over time and leading to significant difficulty with solid food. Some patients may actually have a sensation of reflux, although this could be from retained food in the esophagus.

Symptoms

Achalasia symptoms may include:

• Difficulty swallowing often to solid food but occasionally with liquids
• Waking up at night with a cough or the regurgitation of stomach acid/food debris
• Chest pain particularly after eating
• Weight loss

Types

There are several types and forms of achalasia all which are amenable to treatment. Additionally, there are other disease processes that can mimic achalasia and are important to rule out in making the diagnosis

Diagnosis

Achalasia diagnosis can involve:

• An endoscopy (EGD/scope) of the esophagus, which can demonstrate a hypertensive or overly compliant lower valve
• A barium swallow which is a test where contrast material is swallowed and x-rays are taken which can clearly outline a tapering of the distal esophagus
• Most critical in making the diagnosis is functional esophageal testing called esophageal manometry which will measure pressures throughout the esophagus

Treatment

Achalasia treatment options include:

• Endoscopy and dilation, Botox therapy to the lower esophageal valve and surgical options
• Surgery, which can include a laparoscopic approach with an opening of the distal esophageal valve muscle and a partial wrap to control reflux
• Endoscopic options such as POEM procedure where no incisions are made and the valve is opened through a procedure performed through the mouth

Rarely patients with “end-stage achalasia” required the removal of the esophagus and reconstruction with the stomach