Achalasia Treatment

Esophageal Center at RWJ University Hospital New Brunswick

Achalasia is a disorder that makes swallowing difficult. Nerve damage prevents the muscle (called the lower esophageal sphincter) connecting the esophagus and stomach from relaxing. This creates a backup, making it difficult for food and liquids to pass into your stomach.

Individuals with achalasia will often have difficulty swallowing or a feeling like food is stuck in their throat (also referred to as dysphagia). This may trigger coughing which increases the risk of inhaling or choking on food. Other symptoms of achalasia include:

• pain or discomfort in your chest
• weight loss
• heartburn (acid reflux)
• regurgitation
• intense pain or discomfort after eating

Individuals who are middle-aged and older are at higher risk for developing the condition; however, it can occur in children. Achalasia may be hereditary, and is more common in people with autoimmune disorders.

Diagnosis of Achalasia

Achalasia is usually diagnosed through testing such as esophageal manometry, barium esophagram, or upper endoscopy.

Treatment for Achalasia

Achalasia treatment focuses on relaxing or forcing open the lower esophageal muscle so that food and liquid can move more easily through your digestive tract. There are nonsurgical, endoscopic and surgical treatments available. Specific treatment options will depend on your age and the severity of your condition.

Medical Treatment

Please note: These treatments tend to be less effective in younger age groups.

• Esophageal/Pneumatic Dilation—a balloon is inserted into the esophageal sphincter (the muscle that closes the esophagus) and inflated to enlarge the opening. This outpatient procedure may need to be repeated if the muscle remains too tight and does not stay open. Although nearly one-third of people treated with balloon dilation require additional procedure(s), it is still the primary treatment method for achalasia.
• Medication—an oral muscle relaxant is taken before eating. These medications have limited treatment uses and produce severe side effects. Medication treatment is typically only suggested for patients not eligible for other treatments, such as endoscopic or surgical interventions.

Endoscopic Treatments

The following are minimally endoscopic therapies aimed at treatment of achalasia.

• Esophageal/Pneumatic Dilation—a balloon is inserted into the esophageal sphincter (the muscle that closes the esophagus) and inflated to enlarge the opening. This outpatient procedure may need to be repeated if the muscle remains too tight and does not stay open. Although nearly one-third of people treated with balloon dilation require additional procedure(s), it is still the primary treatment method for achalasia.
• Peroral Endoscopic Myotomy (POEM)—the endoscopist uses an endoscope inserted through your mouth and down your throat to create an incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the muscle at the lower end of the esophageal sphincter is cut.

Surgical Treatment

Most surgical solutions are minimally invasive using laparoscopic or robotic surgical techniques.

• Heller Myotomy—the surgeon cuts the muscle at the lower end of the esophageal sphincter to allow food to pass more easily into the stomach. People who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD).
• Nissen Fundoplication—the surgeon wraps the top of your stomach around the lower esophageal sphincter to tighten the muscle and prevent acid reflux. Fundoplication might be performed at the same time as Heller myotomy, to avoid future problems with acid reflux.

Read more on RWJUH's advanced endoscopic procedures.

Find out more about achalasia treatment at the RWJUH Esophageal Center by calling 732-235-8970.