Achalasia

Achalasia is a rare disorder of the esophagus. Its cause is unknown, but the first symptom is usually difficulty swallowing.

Diagnosing Esophageal Achalasia
Treating Esophageal Achalasia

The esophagus is the muscular tube that carries food from the mouth to the stomach. When you swallow, nerves signal the esophagus to contract and push food through the tube. Other nerves signal a muscle called the lower esophageal sphincter. This muscle acts as a lid that opens to let the food pass into the stomach, and remains closed the rest of the time.

In people with esophageal achalasia, something has gone wrong with these nerves. The muscles do not receive the proper signals to relax at the right time to allow food to pass from the esophagus into the stomach.

Diagnosing Esophageal Achalasia

Symptoms of achalasia typically occur between the ages of 25 and 60. They tend to be mild at first, but grow worse over time.

People with this condition have difficulty swallowing. Other symptoms may include:

• Discomfort or pain in the chest, especially after meals
• Coughing, especially when lying down
• Heartburn
• Weight loss
• Vomiting

In some people, vomiting occurs during sleep, causing food particles or liquid to be inhaled. This can lead to aspiration pneumonia and other respiratory infections.

Tests to diagnose esophageal achalasia include:

• Manometry: inserting a tube down the throat to test pressure when swallowing
• Esophagram: X-rays of the esophagus
• Esophagoscopy: using a fiber optic tube to examine the esophagus

Treating Esophageal Achalasia

The two main treatment options for achalasia include:

• Pneumatic dilation: a balloon is attached to a thin tube and inserted into the throat. The balloon is then inflated to stretch the lower esophageal sphincter to allow it to open properly.
• Myotomy: a surgical procedure that involves making small incisions in the lower esophageal sphincter to help it relax and open properly.

In 2014, Swedish surgeons became the first in Washington State to perform a Per Oral Endoscopic Myotomy (POEM) procedure to treat achalasia. Using a flexible tube called an endoscope, surgeons access the esophagus and upper part of the stomach with no incisions in the chest or abdomen, resulting in a shorter hospital stay and less downtime after the procedure.

Robotic myotomy is another procedure performed at Swedish to treat achalasia. Surgeons use the daVinci Surgical System to access the esophagus through tiny incisions in the abdomenal wall and perform the procedure.