Achalasia

Achalasia is a condition in which the lower part of the esophagus (the passage way for food from the mouth to the stomach) fails to relax resulting in difficulty with swallowing. The exact cause of achalasia is unknown. It is believed that the condition is the result of damage to the nerves that normally help the muscles of the lower esophagus to relax.

Achalasia is a rare disease occurring in one in 100,000 individuals in US each year. Patients may present with difficulty in swallowing, vomiting, regurgitation of undigested food, weight loss, and weakness. Some may develop pneumonia as a result of aspiration of regurgitated food. A small percentage of patients may develop cancer of esophagus.

Diagnosis is usually made with an upper endoscopic exam. A barium swallow x-ray will show tapering of the lower esophagus and widening of the mid to upper segments, suggestive of achalasia. The final diagnostic test is called esophageal manometry, in which a probe is placed in the lower esophagus through the nose, and measurements are recorded.

Although several non-surgical treatments have been attempted, the mainstay of treatment remains surgical. Most medications like calcium channel blockers or Nitroglycerin fail to provide long-lasting effect. Similarly, endoscopic treatments including balloon dilatation or Botox injection fail to provide long-lasting effect and carry the risk of esophageal perforation.

Surgery for achalasia is called laparoscopic Heller myotomy. Using the minimally invasive approach and multiple small incisions, the muscles of the lower esophagus are cut leaving the inner layer intact. This results in relaxation of the affected part and relief of symptoms. An anti-reflux procedure (fundoplication) is also included to prevent future reflux and regurgitation of stomach contents. Although this is a major operation, most patients leave the hospital within 24-36 hours and return to normal activities within one week. Over 90 percent of patients are symptom free after surgery.

Dr. Zaré has over 8 years of experience in performing this operation in large numbers. His patients have overwhelmingly expressed satisfaction with their quick recovery and the dramatic change in lifestyle, being able to eat normal food once again.

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