Achalasia

Achalasia is a rare swallowing disorder in which the esophagus is unable to move food into the stomach.

Achalasia can occur at any age.

Surgeons at WashU Medicine perform minimally invasive procedures, known as per oral endoscopic myotomy (POEM) and laparoscopic Heller myotomy, to treat achalasia.

What is achalasia?

Achalasia is a swallowing disorder caused by damaged nerves in the esophagus.

The esophagus is a muscular tube that carries food and liquids from the throat to the stomach.

Damage to the esophagus prevents the muscles from properly pushing food and liquids towards the stomach. As a result, food accumulates in the esophagus, sometimes fermenting and causing a bitter taste when it washes back up into the mouth.

Achalasia is often mistaken for gastroesophageal reflux disease (GERD).

GERD involves reflux from the stomach, while achalasia involves food coming up from the esophagus.

Symptoms

Symptoms of achalasia generally develop gradually and worsen over time.

They may include:

• Difficulty swallowing (dysphagia), feeling like food or drink is stuck in the throat
• Regurgitation of swallowed food or saliva
• Heartburn
• Belching
• Intermittent chest pain
• Coughing at night
• Pneumonia from aspiration of food
• Weight loss
• Vomiting

Causes and risk factors

The precise cause of achalasia is not well understood. Researchers believe it may be due to the loss of nerve cells in the esophagus.

Potential causes include viral infections or autoimmune responses. In rare instances, achalasia is linked to genetic disorders or infections. Risk factors for the condition include:

• Age: While achalasia can affect individuals of any age, it’s most common in people between 25 and 60 years old.
• Medical conditions: People with allergic disorders, adrenal insufficiency, or Allgrove syndrome (a rare autosomal recessive genetic condition) may have an increased risk of developing achalasia.

Treatment options at WashU Medicine

There is currently no cure for achalasia, but its symptoms can usually be managed effectively.

WashU Medicine offers a range of treatments, including laparoscopic Heller myotomy, per-oral endoscopic myotomy (POEM), and open surgery.

Laparoscopic Heller myotomy

In laparoscopic Heller myotomy, a small incision is made just above the umbilicus (navel).

The surgeon uses laparoscopic surgical tools that fit through small incisions in the abdomen to stretch or widen the esophagus.

POEM procedure

This technique is the least invasive, using incisionless surgery to relax the muscle that connects the esophagus to the stomach.

The POEM procedure (also called per-oral endoscopic myotomy) is technically challenging, but surgeons at WashU Medicine have experience performing it for dozens of people with achalasia each year with excellent outcomes.

Studies have shown POEM and laparoscopic Heller myotomy have similar success rates.

POEM may result in improved outcomes because it allows for a longer myotomy, which involves the cutting of the esophageal sphincter muscle.

Open surgery

Procedures such as Heller myotomy, which require an abdominal incision to cut the esophageal muscles, allow better food passage, but require larger incisions than minimally invasive treatments.