Achalasia is a rare disease which affects the esophagus. About 0.5-1 out of 100,000 people are affected by this disease. The Latin translation of Achalasia is “failure to relax”. Between the lower part of the esophagus and the stomach is a muscle commonly referred to as the sphincter. When the sphincter muscle remains contracted (tight) it becomes difficult for both liquids and solids to pass, often causing vomiting. The actual cause for Achalasia is somewhat controversial with thoughts that it may be as a result of an auto-immune disorder or a viral infection.
Symptoms
Patients most commonly present with symptoms such as difficulty in swallowing liquids or solids, frequent vomiting of both un-digested and digested food particles, heartburn, reflux, unexplained weight loss and chest pain. Some patients may also experience frequent bouts with asthma, chronic laryngitis, pneumonia and pillow soilage.
Treatment
Treatment for Achalasia includes both medical and surgical options. At BMI of Texas, Drs. Englehardt and Duperier will review your symptoms and determine the most appropriate method to treat you. Medical treatments are best suited for patients who are considered poor surgical candidates.
Medical Treatment for Achalasia
- Balloon Dilation – This procedure is generally reserved for patients that do not present as optimal surgical candidates. The procedure is effective about 60% of the time and in many cases requires repeated procedures. It is important to note that balloon dilation is not recommended for patients under the age of 40.
- Botulinum Toxin (Bo-Tox) – This procedure is performed by injecting Bo-Tox directly into the lower muscle (sphincter) fibers of the esophagus. The Bo-Tox serves to paralyze the muscle, which means the muscle cannot contract. Bo-Tox is generally only effective for a few weeks and is therefore not considered to be effective long-term. This should not be done in patients under the age of 50.
- Medication – Typical medications prescribed for temporary relief of Achalasia symptoms are nitroglycerin and calcium channel blockers. Success with these medications is variable.
Surgical Treatment for Achalasia
Procedure
The surgical procedure that is performed to treat Achalaisa is known as Heller Myotomy. The procedure involves the cutting or splitting of the muscle fibers of the distal esophagus right above the stomach. BMI surgeons generally use a robotic surgical approach for this. This involves five tiny incisions in your abdomen for insertion of the laparoscopic instruments. It takes approximately one hour to perform a robotic Heller Myotomy.
Post –Operative Expectations
Surgical treatment for Achalasia generally requires 1-2 nights stay in the hospital. When you leave the hospital you will be placed on a liquid diet that will slowly progress to soft mushy foods for 3 weeks. At your 3 week appointment you will be scheduled for an Upper GI so that your surgeon can see how food is emptying from the esophagus into your stomach. This Upper GI will be compared to one that was performed prior to surgery. The surgical treatment of Achalasia has a greater than 95% long-term success rate. The most common complications after surgery include reflux and heartburn but this is unusual.