Achalasia occurs when there is a failure of the lower part of the oesophagus to relax during swallowing. This affects the ability of the oesophagus to move food into the stomach.
The cause of achalasia is unknown.
- Dysphagia (difficulty in swallowing) to both solids and liquids from an early stage
- Aspiration pneumonia
- Weight loss
- Barium swallow
- Oesophageal manometry
- Gastroscopy (to exclude the presence of oesophageal cancer)
- Botulinum toxin injection
Botulinum toxin is injected into the lower esophageal sphincter during gastroscopy. The toxin will weaken the sphincter muscle and allow it to relax. The effect on the sphincter is temporary and lasts a few months only. It can also cause an inflammatory reaction at the lower part of the oesophagus, making a subsequent surgery very difficult. However, it may be useful in elderly patients who are poor candidates for dilatation or surgery.
- Balloon dilatation
This is a quick and inexpensive procedure. A balloon is placed across the lower oesophageal sphincter during gastroscopy. The balloon is inflated to tear the sphincter. The perforation rate is about 5% and repeated dilatations may also produce scarring.
- Heller’s Oesophagomyotomy Surgery
In an oesophagomyotomy, the muscle at the lower part of the oesophagus is cut surgically to relax the sphincter. In most cases, the operation can be performed in a minimally invasive technique with small "keyhole" incisions in the abdomen. The advantages of a laparoscopic approach are less postoperative pain, early recovery of bowel function, early hospital discharge, early return to work and better cosmetic results.