The esophagus is the tube that carries food from your mouth to your stomach.
A muscular ring located where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. This allows food to move down the esophagus. In people with achalasia, this muscular ring or sphincter does not relax properly. Swallowing is difficult because achalasia affects the ability of the esophagus to move food toward your stomach.
Causes & Risk Factors
Achalasia is a rare disorder caused by damage to the nerves of the esophagus. The disorder may occur at any age, but is most common in middle-aged or older adults; it may also be inherited in some people.1
Symptoms
Achalasia can cause symptoms similar to cancer of the esophagus and upper stomach, as well as a parasitic infection known as Chagas disease. Achalasia symptoms may include:
- Backflow (regurgitation) of food
- Chest pain that may increase after eating
- Chest pain also felt in the back, neck, and arms
- Cough
- Difficulty swallowing liquids and solids
- Heartburn
- Unintentional weight loss
Treatment
Your doctor can help you decide which treatment is best for your situation. The goal of treatment is to reduce the pressure at the lower esophageal sphincter. Treatment may consist of one or more of the following:1,2
Botulinum (Botox) Injection - Botox is injected directly into the esophageal sphincter and may help relax the sphincter muscles. Any benefit wears off within weeks or months and the injections must be repeated. This treatment is usually reserved for elderly patients or those at high surgical risk. BotoxTM was developed from the toxin causing botulism, a form of food poisoning. However, botulism is not a concern with very low doses used as treatment for achalasia. No one has ever developed botulism from this treatment.
Medications - There are several medications for early stage achalasia, such as long-acting nitrates or calcium channel blockers, used to relax the lower esophagus sphincter. The treatment is considered temporary and may cause certain side effects such as low blood pressure and swollen feet which you should discuss with your doctor.
Pneumatic (Balloon) Dilation – This procedure dilates the esophagus at the location of the narrowing. A balloon is inserted into the esophagus to stretch the sphincter (local anesthetic is used to numb the throat). This procedure is successful 50 to 80 percent of the time and does not require hospitalization. If balloon dilatation is successful, its benefits are usually permanent. However, a small number of people may need repeat treatment if the esophageal sphincter contracts. There is also a risk (4 to 5 percent) of esophageal tearing during the procedure. If a tear occurs, emergency surgery is performed to repair the tear.
Surgery - Your doctor may recommend surgery to treat achalasia. Achalasia surgery is called esophagomyotomy or Heller Myotomy and is most frequently done using laparoscopic (minimally invasive) surgery. This procedure lasts about two hours. During the procedure, a laparoscope (a telescope-like instrument) and operating instruments are inserted through several small incisions made in the abdomen. Through the laparoscope, the esophageal sphincter muscle is cut. One to two days in the hospital is usually required. Traditional open surgery through a large incision into the chest or abdomen to cut the sphincter muscle requires up to one week in the hospital.
Traditional open or laparoscopic surgery to cut the esophageal sphincter muscle is successful about 90 percent of the time. If the surgery is successful, the benefits are usually permanent. However, a small number of people may need repeat treatment if the esophageal sphincter contracts or tears. An additional procedure to wrap the upper stomach around the lower esophagus (Nissen Fundoplication) to prevent reflux of stomach content into the esophagus is sometimes done at the same time that the esophageal sphincter muscle is cut.
da Vinci Surgery for Achalasia (Heller Myotomy)
If your doctor recommends surgery to treat achalasia, you may be a candidate for a safe, effective and minimally invasive procedure – da Vinci Surgery. Using the most advanced technology available, da Vinci enables your doctor to perform this delicate operation through a few tiny incisions with breakthrough vision, precision and control.
da Vinci Surgery for Achalasia offers patients many potential benefits over traditional laparoscopic surgery, including:
- Lower risk of esophageal tears (perforations)3,4
- Fewer complications3,4
- Safer and more precise operation3,4
This procedure is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.
1"Achalasia", National Institutes of Health, www.nlm.nih.gov. Available from:
http://www.nlm.nih.gov/medlineplus/ency/article/000267.htm
2Mayo Clinic, Achalasia – Treatment. Available from: http://www.mayoclinic.org/achalasia/treatment.html
3Horgan S, Galvani C, Gorodner MV, et al.; Robotic-Assisted Heller Myotomy Versus
Laparoscopic Heller Myotomy for the Treatment of Esophageal Achalasia: Multicenter Study; J Gastrointest Surg 2005; 9:1020-1030 The Society for Surgery of the Alimentary Tract.
4Huffmanm LC, Pandalai PK, Boulton BJ, et al.; Robotic Heller myotomy: A safe operation with higher postoperative quality-of-life indices; 2007 Surgery, 142 (4), pp. 613-620.
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.
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