What is Achalasia?
Achalasia is a rare swallowing disorder characterized by two problems with the esophagus. The first is a lack of peristalsis, which is the involuntary process of propelling food from your mouth to your stomach. The second is a failure of the lower esophageal sphincter (LES) to relax. Achalasia literally means "failure to relax." It occurs mostly in men and women between the ages of 25 and 60, and affects both sexes equally. The incidence of achalasia is about 1 in 100,000 people a year.
Treatment of achalasia requires an interdisciplinary approach that draws on various medical specialties. At BMC, physicians in our Center for Minimally Invasive Esophageal Therapies provide comprehensive, quality care including medical oncology, radiation oncology, thoracic surgery, gastroenterology, pathology, pulmonary medicine and radiology.
What are the Symptoms of Achalasia?
Symptoms may include:
- Difficulty swallowing
- Weight loss
- Chest pain
- Hiccups or difficulty burping
- Weight loss
What are the Causes?
The causes of achalasia are not fully understood.
How is Achalasia Diagnosed?
Diagnosis is usually made as a result of one or more of the following tests:
How is Achalasia Treated?
Achalasia can be treated surgically and non-surgically. Neither technique is able to completely cure the condition, but both have the ability to improve symptoms.
- Medication—specifically with nitrates and calcium channel blockers—is sometimes able to relax the lower esophageal sphincter (LES) muscles enough to ease achalasia. Recent research has suggested that injections of botulinum toxin (Botox) can also relax the LES by temporarily paralyzing the hyperactive cells that cause contraction.
- There are three ways to perform a myotomy:
- Open surgery, by means of thoracotomy or incision. When used to treat achalasia, this is called a Heller myotomy.
- Laparoscopically, through tiny incisions in the abdomen. A thin, lighted tube called a laparoscope, and other surgical tools, are inserted through the incisions to allow the surgeon to work on the esophagus.
- Robotic myotomy, when a surgeon guides robotic instruments in the abdomen using a computer console. The surgeon's natural hand movements are conveyed to the robotic instruments, which mimick the same movements that would be used if larger incisions, big enough for the surgeons hands, were used. Boston Medical Center was the first center in New England to perform thoracic procedures—such as Heller myotomy—using robotics.