Achalasia

UW Health surgeons treat achalasia, a disorder in which food gets backed up in the esophagus because it cannot pass through to the stomach.

 

What causes achalasia?

 

Achalasia occurs when the lower esophageal sphincter, which is at the bottom of the tube that moves from from the mouth to the stomach, cannot relax properly. Food is unable to pass down into the stomach. Achalasia usually occurs due to nerve damage of the esophagus.

 

What are some of the symptoms of achalasia?

  • Throwing up
  • Heartburn
  • Difficulty swallowing
  • Coughing
  • Weight loss

What are the risks of achalasia if left untreated?

 

Achalasia can lead to malnutrition, anemia or loss of the esophageal function. Untreated achalasia also increases the risk of esophageal cancer.

 

How is achalasia treated?

 

In most cases, achalasia cannot be managed with medication. Since achalasia is a progressive disease with no real cure, early surgical intervention to prevent long-term complications of the disease is usually necessary.

 

Surgical Options for Achalasia: Heller Myotomy

 

During a Heller myotomy, surgeons divide the tight muscle fibers in the lower esophageal sphincter to allow food to pass. In some cases, the surgeon may perform a fundoplication procedure, as well, during which the upper part of the stomach is wrapped around the sphincter or the valve between the stomach and the esophagus.

 

Patients usually spend one night in the hospital and can start drinking liquids right away.

 

Surgical Options for Achalasia: Peroral Endoscopic Myotomy (POEM)

 

During peroral endoscopic myotomy (POEM) procedures, surgeons make a tiny incision into the esophagus to divide the muscles of the esophagus and stomach. If swallowing is normal after surgery, patients can begin a liquid diet that typically lasts three to four weeks. 

 

Advantages of POEM include:

  • Minimal patient discomfort
  • Quicker recovery (typically one night in the hospital)
  • No visible scars
  • Quality-of-life improves as swallowing typically returns to normal one to two days after surgery
  • Patients regain weight as swallowing function improves
  • An endoscopic approach does not require making an incision on the abdominal wall, which may be safer for some patients (for example, those who have undergone previous abdominal surgery)
  • Eliminates concerns about hernias that may potentially form at laparoscopic incision sites

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