Achalasia
A rare disorder where the esophagus cannot move food into the stomach due to nerve damage.
Overview
Achalasia is a rare motility disorder where the lower esophageal sphincter (LES) fails to relax during swallowing, and esophageal peristalsis is absent. Food accumulates in the esophagus, causing progressive dysphagia, regurgitation, and weight loss.
Causes
- Degeneration of inhibitory neurons in the esophageal myenteric plexus
- Autoimmune destruction of ganglion cells
- Unknown trigger (possibly viral)
- Rarely: Chagas disease (in endemic areas)
Risk Factors
- Age 25-60 years
- Equal gender distribution
- No known dietary or lifestyle risk factors
- Genetic predisposition (rare familial cases)
Symptoms
Diagnosis
- Barium swallow (bird-beak appearance)
- Esophageal manometry (gold standard — absent peristalsis, failed LES relaxation)
- Upper GI endoscopy (to rule out pseudoachalasia from tumor)
- CT chest (to exclude malignancy)
Treatment Options
Surgical Treatment
Laparoscopic Heller myotomy with partial (Dor or Toupet) fundoplication is the gold standard surgical treatment. The procedure divides the muscle fibers of the LES, allowing food to pass into the stomach. POEM (Peroral Endoscopic Myotomy) is a newer endoscopic alternative with excellent short-term results.
Recovery
Laparoscopic Heller myotomy: 1-2 days hospital stay, liquid diet for 1 week, soft diet for 2-3 weeks, normal diet by 4-6 weeks. 85-90% of patients achieve good long-term symptom relief.
Prevention
- No known prevention as the cause is unclear
- Early diagnosis and treatment prevents esophageal dilation and complications
- Regular follow-up after treatment to monitor for recurrence
Frequently Asked Questions
Is achalasia curable?
Can achalasia become cancer?
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