Achalasia is a disorder of the esophagus that makes it difficult to swallow solid or liquid foods. This condition occurs most often in middle-aged adults or older adults, but can sometimes occur in children, teenagers, and young adults. In people with achalasia, the lower esophageal sphincter (the ring of muscle between the end of the esophagus and the stomach) fails to relax during swallowing. The esophagus also has difficulty contracting to propel food from the mouth to the stomach. The cause of achalasia is not known.
Achalasia is a rare disorder, affecting about 2,000 people in the United States yearly. Because the condition is so rare, it's important to choose a medical center with experience diagnosing and treating this disorder and other problems affecting the esophagus.
The Center for Advanced Digestive Care at NewYork-Presbyterian/Weill Cornell Medical Center offers comprehensive services, resources, and expertise for the diagnosis and treatment of achalasia. Our team includes some of the most experienced surgeons and gastroenterologists for managing this disorder, ranging from the Gastroesophageal Motility Disorders Laboratory for diagnosis and surgical intervention, to medical approaches, endoscopic techniques, and thoracic surgical procedures.
A key feature of achalasia care at NewYork-Presbyterian/Weill Cornell is our team approach: surgeons use minimally invasive surgical techniques and gastroenterologists use endoscopic techniques to treat this condition. Minimally invasive and endoscopic surgery offer patients a faster and more comfortable recovery, with less pain than traditional open surgery.
The difficulty swallowing experienced by most patients with achalasia may last months or even years before a person seeks help. Patients usually complain of intermittent regurgitation (food coming back up into the esophagus from the stomach) and food feeling like it is "sticking" in the esophagus after swallowing.
Other symptoms include:
- Regurgitation of food
- Chest pain after eating
- Weight loss
- Difficulty swallowing (dysphagia)
Proper diagnosis is the first step toward the appropriate and effective treatment of achalasia. Physicians at NYP/Weill Cornell employ several tests to determine the exact nature of the problem and to rule out the presence of esophageal cancer. Diagnostic testing may include:
- Upper GI (gastrointestinal) series (also called barium swallow): this test involves swallowing a liquid that can be seen on x-rays as it goes down the esophagus.
- Endoscopy: examination of the esophagus using a flexible tube with a camera at its tip.
- Manometry: a test that measures the pressure, strength, and coordination of the muscles in the esophagus. For this test, a very thin tube is passed through the nose and down into the stomach. The test then measures esophageal muscle function while the patient swallows sips of water. Manometry also evaluates the function and relaxation of the lower esophageal sphincter. Patients with achalasia typically have an elevated lower sphincter pressure and experience failure of the sphincter to open when they are swallowing.
Drugs that relieve the spasm of the lower esophageal sphincter have largely been unsuccessful as a treatment for achalasia, and they cause numerous side effects. The classical methods for treatment are "endoscopic balloon dilatation" and surgery. While dilatation can achieve a good result in up to 60 percent of patients, the benefits often don't last. There is also a risk of perforating the esophagus during dilatation, which requires emergency surgery.
Botulin toxin (Botox®) injection is used in some patients to paralyze the sphincter muscle and prevent muscle spasms.
Laparoscopic Esophageal Myotomy
A surgical procedure called laparoscopic esophageal myotomy can decrease the pressure of the lower esophageal sphincter muscle and make it easier to swallow. This minimally invasive procedure is performed through five tiny incisions measuring between 5mm and 1cm. The surgeon releases the muscles around the lower esophageal sphincter, relaxing this valve and allowing food to pass into the stomach more easily. To prevent reflux after the procedure, surgeons typically perform a partial wrap of the stomach around the esophagus.
Peroral Endoscopic Myotomy
Surgeons at NYP/Weill Cornell offer an approach that is even less invasive than laparoscopic myotomy, called peroral endoscopic myotomy (POEM). With the patient under general anesthesia, the surgeon introduces an endoscope through the patient's mouth and into the esophagus. Once near the lower esophageal sphincter, the surgeon cuts the dysfunctional muscles that are preventing the sphincter from opening, allowing food to enter the stomach more easily.
After peroral endoscopic myotomy, patients typically stay in the hospital for about two days, with minimal discomfort. Patients are able to eat regular food by the time they are ready to leave the hospital.
For more information about achalasia care at the Center for Advanced Digestive Care, visit the Gastroesophageal Motility Disorders Laboratory site, our advanced interventional endoscopy section, and the Weill Cornell thoracic surgery website.