Treating Achalasia Patients with Care
Achalasia is a rare disorder of the lower muscle of the esophagus known as the lower esophageal sphincter (LES). Achalasia is caused by damage to the esophageal nerves, which prevents the esophagus from working properly to move food and liquid down the esophagus. In addition, nerve damage prevents the LES from opening and allowing food to enter the stomach. As a result, food and saliva accumulate in the esophagus. When the pressure from food and liquid builds up in the esophagus and reaches a certain point, the pressure will force the sphincter to open and release the food into the stomach. Over time, the walls of the esophagus will weaken causing the esophagus to become dilated and baggy. Food and liquid sitting in the esophagus, known as stasis, will begin to break down and ferment causing damage to the lining of the esophagus. This increases the risk of developing squamous cancer of the lining of the esophagus.
Common Achalasia Symptoms
Achalasia affects a patient’s quality of life, limiting the types and amounts of food they can eat and causes several unpleasant symptoms including:
- Difficulty swallowing – known as dysphagia of undigested food and liquid is the most common symptom of achalasia. Some patients describe it as the sensation of food and liquid "getting stuck."
- Chest pain – Achalasia may cause severe pain in the middle of the chest that can be mistaken for a heart attack.
- Regurgitation of food – Regurgitation is the backward flow from the esophagus into the mouth. Waking up at night coughing and choking may be a symptom of nighttime regurgitation. Regurgitated food and liquid may be aspirated into the lungs causing aspiration pneumonia.
- Unintentional weight loss – Over time, patients may lose weight because they are limited in the types and amount of food they are able to eat.
Treatments for achalasia include both nonsurgical and surgical approaches. The goal of all these approaches is to weaken (relax) the lower esophageal sphincter muscle to allow food and liquid to pass into the stomach.
- Medications such as calcium channel blockers or long-acting nitrates can be used to help relax the lower esophageal sphincter muscle.
- BOTOX® may be injected to the area around the lower esophageal sphincter to help weaken the muscle. The effect of BOTOX is temporary lasting several weeks to months and in some patients may not work at all.
- Dilation of the lower esophageal sphincter using a balloon (pneumatic dilation) may be performed to weaken the muscle. A balloon is inflated at the lower esophageal sphincter to dilate (stretch) the sphincter to weaken the muscle.
- Laparoscopic Heller myotomy is a minimally invasive surgical procedure where the lower esophageal sphincter will then be cut (myotomy) lengthwise to weaken the muscle. Laparoscopic Heller myotomy is a durable surgical procedure and last longer than BOTOX or pneumatic dilation.
Peroral Endoscopic Myotomy (POEM)
Peroral Endoscopic Myotomy (POEM) is an innovative advanced endoscopic procedure which has become the first line therapy for Achalasia in expert Achalasia referral centers. In 2009, Stavros N. Stavropoulos, MD was the second surgeon in the world and the first in the United States to perform a POEM procedure. POEM is a scarless minimally invasive procedure which is performed endoscopically through the mouth. The same cut as in the Heller myotomy is made to the lower esophageal sphincter without surgical incisions into the abdomen. Dr. Stavropoulos is one of the foremost thought leaders in the field of advanced endoscopy, traveling extensively around the world lecturing and teaching specialized techniques, including POEM. To date, Dr. Stavropoulos has performed more than 600 POEM procedures, the most in the United States.