Achalasia

What Is Achalasia?

The cause of achalasia is not completely understood. Some attribute the lack of muscle relaxation in the lower esophageal sphincter to a neurological problem. Others have considered a genetic component. The reality is that at the time of this writing the true etiology of achalasia is not known. 

Most patients with achalasia complaint of dysphagia or difficulty swallowing. The symptom usually starts gradually and continues to progress with time. The typical patient will start noticing difficulty swallowing certain solids like chicken breast, turkey breast, bread, and hard vegetables.  With time the patients will start noticing difficulty swallowing liquids. Many patients won’t seek medical attention until the symptoms are advanced. Many will compensate by eating slowly, chewing the food longer, eating standing up or sitting really straight. 

Other patients will complain of chest pain when eating, regurgitation of undigested food of several days prior or bad breath (halitosis). Some will mention chronic cough at night with a significant lack of sleep due to aspiration of undigested food. In severe cases, patients can be significantly underweight and malnourish. 

The first step in the diagnosis is a good history and physical exam. In patients with the above symptoms, the diagnosis is usually suspected.

An Upper GI Series or Barium Swallow Test is usually the first test performed. It is a cheaper and non-invasive test. The classic findings are a very narrow passage of contrast through the lower esophageal sphincter and proximal dilation of the esophagus.

An EGD or Upper Endoscopy is another commonly perform test in patients with achalasia. Patients with esophageal cancer, esophageal strictures from chronic reflux or upper stomach cancer can have a similar presentation to achalasia. This is called pseudoachalasia or secondary achalasia, so making a distinction is very important. The endoscopy can also be used for the treatment of achalasia.

The gold standard test in the diagnosis of achalasia is a High-Resolution Esophageal Manometry or an Esophageal Motility Study. This test is usually mandatory in order to confirm the diagnosis of achalasia. During the test, an electrode is placed in the esophagus and the patient is given something to swallow. After ten swallows the electricity generated by the esophagus is measured and the diagnosis is made. The classic findings for achalasia are, a hypertensive or tight lower esophageal sphincter that doesn’t relax with every swallow and lack of peristalsis (contractions) of the body of the esophagus.

Because the operation is done minimally invasive the patient will experience less pain, faster recovery and faster return to regular activities when compared to an open procedure.

After surgery, you will be in the recovery room for 2-3 hours. You will be admitted to the hospital admission for 1-2 days. Your diet will be advanced slowly, the first day after surgery you will be on clear liquids and day two on full liquids. You will be discharged home on a full liquid diet for 2 weeks. After that, you will be on a soft diet for two more weeks. Once you have completed the 4 weeks of the liquid and soft diet you should be able to tolerate regular food. 

Some patients can experience difficulty eating certain foods even after surgery because of the chronic damage to the esophageal motility that happens with Achalasia. This is more pronounced in patients that suffered from achalasia for a long period of time before seeking surgical treatment. 

You will follow up with Dr. Caban in 2-3 weeks and at 3 months after surgery.

Most patients that have office type job can expect to return to work after 1-2 weeks. For those of you that have a heavy labor job were heavy lifting more than 15-20 pounds is necessary, you should account for 4-6 weeks out of work.