Achalasia

Achalasia is a rare disorder of the esophagus, the tube that carries food from the throat to the stomach. People who have achalasia have difficulty moving liquid and food into their stomach.

Symptoms

Symptoms of achalasia usually start gradually. Most patients first notice they have trouble swallowing or have a chest pain that comes and goes.

Other symptoms include:

  • Spitting up undigested food
  • Heartburn
  • Cough at night
  • Hiccups and/or difficulty belching
  • Weight loss/malnutrition

Patients who have achalasia are at a higher risk for cancer of the esophagus and of infections of the lung because of food and liquid being aspirated into the lungs.

Causes

The exact cause of achalasia is not known. Researchers believe the condition may be caused by the degeneration of a group of nerves located in the chest (Auerbach’s plexus). Researchers also believe achalasia may be inherited, but more research is needed to understand if it is a genetic disorder.

Diagnosis

MetroHealth can diagnose achalasia in several different ways:

  • Barium swallow: Patients swallow a barium preparation (liquid or other form), and a series of x-rays track the movement of the barium through the esophagus. The barium swallow will show a narrowing of the esophagus that would cause achalasia.
  • Upper endoscopy: A flexible, narrow tube with a camera on it is passed down the patient’s esophagus, which allows the specialist to see cancerous lesions or achalasia.
  • Manometry: This test measures the timing and strength of the esophageal muscle contractions and relaxation of the lower esophageal sphincter (LES). If the LES fails to relax in response to swallowing and there are no muscle contractions along the walls of the esophagus means a patient has achalasia.
  • EndoFLIP (Endoscopic Functional Luminal Imaging Probe): This test is performed at the time of the endoscopy where real time measurements of the esophagus function and sphincter tightness can be performed.

Why Choose MetroHealth for Treatment

MetroHealth’s Endoscopic Surgery Team performs the newest procedure to treat achalasia: Peroral endoscopic myotomy (POEM). This is slowly becoming the “gold standard” for first line management of achalasia.

This procedure is minimally invasive and an alternative to other procedures like the laparoscopic Heller myotomy. In this specialized procedure, muscles on the side of the esophagus, the LES and the upper part of the stomach are approached with an endoscope and cut with a knife. The cuts in these areas loosen the muscles, allowing the esophagus to empty like it normally should, passing food and liquid down into the stomach. There are no external incisions during POEM.

After the surgery, the patient has an overnight hospital stay and a repeat upper gastrointestinal swallow (UGI) evaluation the next day. After discharge, patients can rapidly return to full activity. There are no restrictions on activity and returning to work, and patients will slowly advance their diet as tolerated over the following few weeks.

To learn if MetroHealth can help you with your achalasia treatment, call 216-778-8917. 

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