Achalasia happens when the processes that move food to your stomach don’t work like they should. For food and liquids to pass from your mouth to your stomach, two things have to happen after you swallow. First, the esophagus, the tube that carries food to your stomach, has to move the food along by squeezing and relaxing. Once the food reaches the stomach, a small muscle flap or valve at the bottom of the esophagus must open to let the food empty into the stomach.
If you have achalasia, neither of these processes works well. The esophagus can’t push food down. Also, the valve doesn’t open up completely. This causes food to get caught at the base of the esophagus, like a clogged sink, and wash up back into your mouth.
Achalasia is rare. Approximately 1 in 100,000 people will get it. It can take years to develop, and some people ignore the symptoms for years before they go to a doctor. Although the condition can’t be cured, treatment will help you live with it.
Achalasia Symptoms
The biggest symptom of achalasia is trouble swallowing liquids and solid food.
Eating within 4 hours of going to bed may make symptoms worse. Foods such as meat and bread may also cause trouble.
Achalasia Treatment
Surgery
Surgery is the most successful achalasia treatment. With surgery, most people will get long-term relief from symptoms.
The most common procedure is called a Heller myotomy. Most of the time it’s done using a scope with a camera and a light, along with other instruments. The doctor makes several tiny cuts into the abdomen, and uses the surgical tools to reach the area they need to work on. The goal of the operation is to open part of the lower esophagus to make swallowing easier. It’s usually very successful.
Another surgical option is called peroral endoscopic myotomy, or POEM. With this procedure, doctors don’t have to cut outside the body. Instead, the doctor inserts an endoscope (a small tool with a camera on the end) into the mouth and down the throat. Once they see inside, they make a small cut to the internal lining of your esophagus. They tunnel through it to reach the inner muscle of the lower esophagus, where they make another cut. This helps make swallowing easier.
Achalasia Diagnosis
Because the symptoms of achalasia are so much like heartburn, your doctor may treat you for heartburn first. If that doesn’t work, they probably will test you for achalasia.
They may look down into your throat with a special tool called an endoscope. It has a tiny camera attached to a long tube so the doctor can see down your esophagus.
The barium swallow test is a common screening test for achalasia. So is a test called manometry. A doctor runs a thin tube down your throat to test the strength of the esophagus muscles as you take sips of water. It also measures how well your stomach valve works.
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