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Achalasia

Achalasia is a rare disorder of the esophagus that drastically limits your ability to move food and liquids through your esophagus to your stomach. The muscles of the esophagus don't contract the way they're supposed to, propelling food down. Also, the end of the esophagus, known as the lower esophageal sphincter (LES), does not fully relax to allow food and liquids to enter the stomach.

Though achalasia can affect people of all ages, including children, it is most often found in people in their 40s and 50s. It is thought that achalasia is caused by nerve damage to the esophagus.

People with achalasia generally experience dramatic weight loss and are often malnourished. With proper treatment, most people are able to eat normally again.

Achalasia symptoms

Symptoms of achalasia may slowly get worse over a period of months or even years. Achalasia symptoms may include one or more of the following:

  • Backflow or regurgitation of food
  • Trouble swallowing fluids and solids
  • Chest pain, which might increase after eating or which can also be felt in the back, neck or arms
  • Cough
  • Bad breath
  • Heartburn
  • Unintended weight loss

How can I get help for achalasia?

See your primary care physician if you are experiencing symptoms of achalasia. After examining you, your doctor may refer you to a specialist who has the expertise and resources to diagnose and treat this rare disorder, such as a thoracic surgeon, gastroenterologist or otorhinolaryngologist (ENT).

Care for achalasia at Rush

A skilled and experienced surgeon is needed to treat rare conditions of the esophagus such as achalasia. Your surgeon at Rush will work with you to discover the cause of your symptoms and determine the most effective course of treatment.

Diagnosis

  • Manometry: A thin pressure-sensitive tube is passed through your nose to see if your esophagus is contracting properly and whether your lower esophageal sphincter valve is relaxing as it should.
  • Endoscopy: In a procedure called an esophagogastroduodendoscopy, a thin, flexible scope is guided through your mouth, down your throat and into the esophagus and upper gastrointestinal (GI) tract to give your doctor a close look at what is going on.
  • Upper GI X-ray: For this test, you will first need to swallow barium, which is mixed in a drink the consistency of a milkshake. Your specialist then tracks the barium as it goes through your esophagus and stomach, via X-ray imaging called fluoroscopy.

Treatment

The overall goal of treatment is to reduce the tightness of the lower esophageal sphincter, allowing food and liquids to pass into your stomach. While surgical treatment and non-surgical treatments are effective in treating achalasia, in some patients, symptoms can return months or even years later.

Your doctor will discuss your treatment options with you and answer any questions you may have. Treatment may include one or more of the following:

Nonsurgical options

  • Medication: Your doctor may try long-acting nitrates or calcium channel blockers to relax the lower esophagus sphincter. However, medication alone has a low rate of relieving symptoms in most patients.
  • Botulinum toxin injections: Your specialist may recommend botulinum toxin injections (e.g., Botox) to relax the muscles that relate to the lower sphincter in the esophagus. This is an effective, yet short-term solution, which needs to be repeated every few months.
  • Dilation: Dilation or widening of the esophagus at the site of narrowing can be an effective method of treating achalasia. Your surgeon inserts a scope though your mouth to guide dilators that stretch the area of esophagus that does not fully relax.

Surgical options

Your surgeon may perform one or more of the following procedures:

  • Heller esophagomyotomy is a reliable and time-tested procedure to relieve the lower esophageal sphincter. It is considered the gold standard for the treatment of achalasia.
    • The esophagus consists of several layers; in this procedure, the outer muscle layers are cut lengthwise to relieve the tightness that is preventing food and liquid from passing through easily, while the inner layer of the esophagus is left intact.
    • The procedure is usually performed laparoscopically, where your surgeon makes a few very small incisions, and inserts a viewing scope as well as instruments through these incisions to perform the surgery. This means you may have a quicker recovery and less pain than you would with open surgery. You will most likely be able to return home the day after the surgery.
  • Partial fundoplication may be performed at the same time to strengthen the lower esophageal sphincter and prevent acid reflux from traveling up the esophagus.
    • During the procedure, your surgeon wraps part of your stomach around the bottom of your esophagus to create pressure that helps stop food and liquid from leaking back up, which damages your esophagus over time.
  • Esophagectomy may be necessary in the most severe cases of achalasia.
    • When the esophagus is no longer functional, your doctor may need to remove all or part of your esophagus and then rebuild it using part of the stomach.
    • You will recover in the hospital for up to two weeks.
    • During that time, you'll have a feeding tube to keep you nourished, and will start drinking and eating again gradually. Many people return to a normal diet as they continue to recover at home.

Why choose Rush for achalasia care

  • Expertise: Gastroenterologists at Rush diagnose and treat the full range of gastrointestinal conditions, including achalasia, Crohn's disease, ulcerative colitis and celiac disease. Our gastroenterology program is ranked among the best in the nation by U.S.News & World Report.
  • Advanced diagnosis and treatments: Thoracic surgeons at Rush are recognized leaders in minimally invasive and traditional approaches to diagnosing and treating disorders of the lungs, chest wall, esophagus and diaphragm, including achalasia.
  • Customized care: The Voice, Airway and Swallowing Program at Rush features ENT specialists who are dedicated to providing comprehensive care for conditions like achalasia that affect your ability to swallow.

Departments and programs that treat this condition