Achalasia

What is Achalasia?

Achalasia is a rare oesophageal disorder that is broadly characterized by the failure of lower esophageal sphincter to relax in addition to the absence or abnormal contraction of the oesophagus. Dysphagia (swallowing difficulty) is most common symptom, although many patients may present with others mimicking reflux, chest pains and un-explained weight loss. Patients generally present in the younger years, although they can present at advanced age (80+), whereby weight loss is a dominant issue. Only in hindsight, dysphagia had been an under-reported problem.

What are the consequences of Achalasia?

We do not know the underlying causative reason. However as the disease progresses, the oesophagus can increase in size and become floppy. Hence food and fluid can stay stagnant for many hours and days. This may lead to bad breath. Patients with achalasia are more predisposed to cancers of the esophagus. This tends to be the squamous type cancers. The incidence of developing cancer is small but the relative risk compared to the normal population is increased.

Treatment options?

  • Medication- Calcium channel blockers & nitrates. This has a generally poor result
  • Botox injections- Results are generally poor and not durable. It can make subsequent surgery difficult as scarring can take place. However its use can be diagnostic and may help in patients who are not fit for surgery.
  • Pneumatic dilatations- This blindly stretches and tears the lower esophageal muscle. There is also a risk of perforation (making a complete hole) and may require emergency surgery. It can also make subsequent surgery difficult. Most patients will require more than 1 dilatation. To date, the longevity of these results do not measure up against surgery.
  • Surgery- Heller’s Myotomy with or without an anti-reflux procedure.
  • POEM- Per Oral Endoscopic Myotomy. This is similar to a Heller’s Myotomy, except done via a gastroscope through the mouth. This is a relatively new procedure with similar results to a Heller’s Myotomy
upper gi achalasia

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