Treatments for patients with acalasia include balloon dilatation and surgery (laparoscopic Heller’s cardiomyotomy). Other options such as Botox injections or revisional surgery are possible.
What is Achalasia?
Achalasia is a rare swallowing disorder. There are two main problems:
- The muscles of the lower oesophagus (the passage from your mouth to your stomach) do not
work effectively and your food is not pushed down into your stomach.
- The muscle sphincter at the lower end of your oesophagus, which should open to allow the
food into your stomach and prevent it flowing backwards, does not function effectively.
What are the symptoms of Achalasia?
Achalasia generally has a slow onset and tends to gradually worsen over time. The main symptoms are:
- difficulty swallowing;
- vomiting and regurgitating food immediately after a meal;
- unintentional loss of weight;
- chest pain that is worse after a meal;
- feeling full after only a small amount of food;
- coughing due to food and fluid entering the windpipe and lungs.
What are the main treatment options?
The main treatment options are
- Balloon dilatation
- Surgery – Heller’s laparoscopic cardiomyotomy
The muscle at the lower end of your oesophagus can be stretched or dilated using a special balloon during the endoscopy and will relieve symptoms for many people. Treatment may have to be repeated more than once.
The procedure can be performed under sedation or a general anaesthetic. An endoscope is gently passed down into your oesophagus and any residual food or fluid will be suctioned away. A guidewire is passed down through the endoscope, the endoscope is removed, then the balloon is passed over the guidewire into the correct position. The balloon is then inflated for a short time, approximately 2 minutes, then deflated and removed.
The endoscopist may then wish to look at the area again with the endoscope to check everything
What are the complications of balloon dilation?
• Chest infection or pneumonia if food or fluid residue is inhaled into the lungs.
• Damage to the wall and lining of the oesophagus.
• Bleeding due to damage.
• Acid reflux because the muscle sphincter will now be relaxed and may allow stomach acid to leak back up into the oesophagus.
• Perforation of the oesophagus which will mean admitting you to hospital and in severe cases, surgery to repair the damage.
Laparoscopic Heller’s cardiomyotomy
The Heller myotomy is a laparoscopic (minimally invasive) surgical procedure used to treat achalasia. It is essentially an esophagomyotomy, the cutting the esophageal sphincter muscle, performed laparoscopically. The operation’s success rate is very high and usually permanent. A small number of patients may need additional treatment.
In the procedure, several tiny incisions are made and a small scope inserted, through which miniature surgical instruments are passed. The scope is connected to a video camera which then sends a magnified image to a monitor, allowing the surgeon to envision the anatomy and manipulate the instruments.
The advantages of the Heller myotomy include:
- Less post-operative pain
- A 1-2 day hospital stay vs. up to a week with a conventioonal open procedure
- Faster recovery from surgery
- A more rapid return to work and normal activities