Achalasia

Achalasia is a disorder that prevents food from moving through the esophagus, the tube that connects the mouth to the stomach. At the junction of the esophagus and stomach, there is a valve that regulates how much food enters the stomach. In achalasia the valve does not relax to allow for the proper entry of food into the stomach. This is due to the loss of peristalsis, the wavelike contractions that move food in a synchronous manner down to the stomach.

A loss of nervous innervation to the esophagus – a condition caused by cancer, infection, and hereditary factors – can also lead to achalasia. Common symptoms include chest pain that extends to the back, neck, and arms after eating, as well as coughing, difficulty swallowing, food regurgitation, heartburn, and weight loss. 

Evaluations

The specialists at UT Southwestern Medical Center may perform one or more of the following procedures to diagnose achalasia:

  • Endoscopy to look directly at inner walls of the esophagus to evaluate narrowing
  • Esophageal manometry to confirm no peristalsis via pressure tests
  • Physical examinations to identify signs of anemia
  • Upper GI and small bowel series to evaluate peristalsis
  • X-ray using barium contrast to see lower esophagus narrowing

Treatments

The following treatment options are offered at UT Southwestern:

  • Balloon dilation of the lower esophagus
  • Calcium channel blockers/long-acting nitrates to reduce pressure in the esophagus
  • Heller Myotomy, as a last resort, to cut the muscle where the esophagus and stomach meet so that food can pass though
  • Injection of botulinum toxin to prevent spasms of the esophagus
  • Surgery to manipulate the valve at the stomach-esophageal junction (lower esophageal sphincter) to reduce pressure