Achalasia is a rare disorder that causes difficulty swallowing, due to abnormal contraction of the esophagus and the failure of the lower esophageal sphincter (the ring of muscle between the end of the esophagus and the stomach) to relax. Because it is so rare, not all medical center have clinicians with experience diagnosing and treating achalasia and other problems affecting the esophagus. At NewYork-Presbyterian, we have a dedicated esophageal disorders program offering comprehensive diagnostic testing and advanced endoscopic and surgical treatments to relieve your achalasia symptoms — restoring your ability to eat and drink comfortably and enhancing the quality of your life.
A Team of Achalasia Specialists
A key feature of achalasia care at NewYork-Presbyterian is our team approach: surgeons and gastroenterologists use minimally invasive techniques, both surgical and endoscopic techniques to treat this condition. Your health care team also includes expert motility specialists to ensure you have the most up to date diagnostic testing. Your team will evaluate your symptoms and choose the most appropriate treatment to restore your esophageal function and comfort.
Advanced Diagnostic Testing
The diagnosis of achalasia requires special “motility testing” to see how well your esophagus is working to push food down toward your stomach. At NewYork-Presbyterian, our state of the art motility labs use the latest techniques to determine the exact cause of your swallowing difficulty Some of the testing we use includes:
- 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 your esophagus.
- Endoscopy. Examination of your 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 your esophagus. For this test, a very thin tube is passed through your nose and down into your stomach. We then measure esophageal muscle function while you swallow sips of liquid. Manometry also evaluates the function and relaxation of your lower esophageal sphincter. People with achalasia typically have an elevated lower sphincter pressure.
- Endolumenal functional endoluminal imaging probe (Endoflip). A new device to help evaluate the lower esophageal sphincter.
Nonsurgical Treatments for Achalasia
Drugs that relieve the spasm of the lower esophageal sphincter have been largely unsuccessful as a treatment for achalasia, and they cause numerous side effects. The traditional methods for treatment are pneumatic balloon dilatation (performed during endoscopy) and surgery. Pneumatic dilation can achieve results equivalent to surgery in properly selected patients and does not require hospitalization. While it may not be as long lasting as surgery, it is an important option for many patients to consider. Botulin toxin (Botox) injection is used in some people to improve sphincter emptying. However, the results are not as good as other treatments and usually last 6-12 months for the first injection.
Endoscopic Treatment of Achalasia
At NewYork-Presbyterian, we offer an innovative treatment for achalasia called peroral endoscopic myotomy (POEM), which is only available at medical centers with the expertise and resources to offer such advanced therapies. When you are fully sedated under general anesthesia, the gastroenterologist introduces an endoscope through your mouth and into your esophagus. Once near the lower esophageal sphincter, the endoscopist cuts the dysfunctional muscles that are preventing your sphincter from opening, allowing food to enter your stomach more easily. This incisionless technique simulates the traditional surgical technique.
Minimally Invasive Achalasia Surgery
A surgical procedure called laparoscopic Heller Myotomy can decrease the pressure of the lower esophageal sphincter muscle and make it easier to swallow. The surgeon performs this minimally invasive procedure through five tiny incisions (between 5mm and 1cm) in your abdomen to release the muscles around the lower esophageal sphincter, relaxing this valve and allowing food to pass into your stomach more easily. To prevent reflux after the procedure, the surgeon typically performs a partial “wrap” of the stomach around your esophagus.