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Treating Achalasia Patients with Care

Achalasia is a rare disorder of the lower muscle of the esophagus (lower esophageal sphincter, or LES) caused by nerve damage which prevents the sphincter from opening and allowing food to enter the stomach. As a result, food and saliva accumulate in the esophagus building enough pressure to force the sphincter to open and release the food into the stomach.

Common Achalasia Symptoms

Symptoms of achalasia include:

  • Chest pain – Sometimes achalasia can cause severe pain that can be mistaken for a heart attack.
  • Cough – This achalasia symptom can often be worse at night.
  • Difficulty swallowing – Also known as dysphagia, difficulty swallowing foods and liquids is the most common symptom of achalasia. Patients describe it as a feeling of the food “getting stuck.”
  • Heartburn – When the lower esophageal sphincter doesn’t close completely, food or stomach acid can back up reflux) into the esophagus and cause heartburn and other symptoms.
  • Regurgitation of food – This can happen when the esophagus is dilated and the trapped food backs up into the mouth.
  • Unintentional weight loss – This happens as the patient’s diet becomes more and more restricted.

In addition to unintentional weight loss, other complications of achalasia are:

  • Aspiration Pneumonia – Achalasia can cause patients to inhale stomach contents into the lower airways of their lungs resulting in frequent bouts of pneumonia.
  • Esophageal cancer – Achalasia also increases the risk of developing squamous cancer of the esophagus.
  • Tearing of the esophagus – This is a possible complication of esophagus dilation treatment.

Effective Achalasia Treatments

Treatments for achalasia include both nonsurgical and surgical approaches:

  • Esophagomyotomy – Performed by incision or by a minimally invasive laparoscopic procedure, achalasia surgery decreases the pressure in the lower sphincter more effectively than the dilation procedure. This treatment option is often used if dilation of the esophagus is not effective or lasting.
  • Injection with botulinum toxin (BOTOX) – This temporary treatment may help relax the lower sphincter muscle for weeks or even months.
  • Medications – Medications such as calcium channel blockers or long-acting nitrates can be used to relax the lower sphincter muscle.
  • POEM (Peroral Endoscopic Myotomy) – A minimally invasive surgical approach that uses an endoscope inserted through the mouth to repair the lower esophageal sphincter.
  • Widening (dilation) of the esophagus – The patient swallows a tube with a balloon at the end which is then inflated to forcefully dilate the esophagus.