Achalasia

With comprehensive services, resources and expertise focused specifically on problems related to the esophagus, the University of Chicago Center for Esophageal Diseases is uniquely qualified to address the diagnosis and treatment of achalasia and other disorders of the esophagus. Our team includes some of the most experienced surgeons in the world for treating achalasia, a rare disorder characterized by difficulty swallowing.

The University of Chicago Medicine has a unique approach to achalasia care, characterized by our surgeons’ ability to use minimally invasive surgical techniques for treating this condition. Because it is done through several small incisions instead of one larger incision, minimally invasive surgery offers patients a faster and more comfortable recovery, with less pain than traditional open surgery and minimal scarring.

About Achalasia

Achalasia is a disorder of the esophagus that makes it difficult to swallow solid or liquid foods. About 70 percent of patients with achalasia also experience regurgitation (backflow) of food. Heartburn and chest pain also may be present with achalasia. Although it can develop in children and adults, this condition occurs most often in middle-age adults or older adults. The condition occurs when the esophageal sphincter muscle (located between the esophagus and the stomach) doesn’t relax as much as it should, which makes it hard for food to pass from the esophagus into the stomach. The etiology of this disease is not known.

Achalasia is a rare disorder--only about 2,000 people in the U.S. are diagnosed each year. Because the condition is so rare, it’s helpful to choose a medical center with experience in diagnosing and treating this disorder and other problems of the esophagus. Our surgeons have performed more than 350 laparoscopic surgical procedures to treat achalasia, and have results that compare favorably with any surgeons in the world.

Symptoms

Achalasia is one type of several different esophageal motility disorders. The most frequent symptom of achalasia is difficulty swallowing. This difficulty may last months or even years before a person seeks help. Other symptoms include:

  • Regurgitation of food
  • Heartburn
  • Chest pain after eating
  • Cough
  • Weight loss

Diagnostic Tests Define the Problem

Proper diagnosis is the first step toward appropriate and effective treatment. Physicians at the University of Chicago may recommend any of several tests to determine the exact nature of the problem and to rule out the presence of esophageal cancer. Diagnostic testing may include:

  • X-ray of the chest and upper GI (gastrointestinal/digestive system) tract
  • Endoscopy. Insertion of a thin, flexible tube down the throat, through the esophagus and into the stomach. The endoscope is equipped with a tiny camera that enables the physician to actually see inside the esophagus and other organs. This test is important to make sure cancer is not present.
  • Manometry. This is a test that measures the strength and coordination of the muscles in the esophagus. For this test, a very thin tube is passed through the nose and down to the stomach. The test then measures esophageal muscle function while the patient swallows sips of water. Manometry also evaluates the function and relaxation of the valve (lower esophageal sphincter) located between the esophagus and stomach.

Treatment

A surgical procedure called laparoscopic esophageal myotomy can decrease the pressure of the lower esophageal sphincter muscle and make it easier to swallow.

Laparoscopic esophageal myotomy is a minimally invasive surgical procedure performed through tiny incisions using miniaturized instruments. The surgeon severs muscles of the valve located between the esophagus and stomach, which makes it easier for food to pass through. Compared to traditional myotomy surgery (done through a large incision in the abdomen or side of the chest), patients undergoing laparoscopic myotomy experience faster and easier recovery with much less pain. After the laparoscopic procedure, patients usually only need one night in the hospital, and then can recover at home. Patients usually leave the hospital the first day after the operation after eating breakfast.

In addition to laparoscopic esophageal myotomy, the University of Chicago Medicine offers a full range of treatment options, including:

  • Endoscopic dilation to widen the lower esophagus.
  • Botulin toxin (Botox) injection to paralyze the sphincter muscle and prevent muscle spasms.

Oral medications are not effective for treating achalasia.

Once the operation is performed, follow-up is regularly done every six months to monitor the patient’s swallowing ability. Patients who come to the University of Chicago for surgical treatment but who live far away can receive follow-up care from their local doctor; however, the team from the University of Chicago Medicine remains in contact with the patient by phone or e-mails as needed over the long term.

Team Dedicated to Resolving Esophageal Problems

Our team at the University of Chicago Center for Esophageal Diseases includes specialists with extensive experience in diagnosing and treating the full spectrum of disorders of the esophagus, from achalasia and other swallowing or motility disorders, to gastroesophageal reflux disease (GERD), Barrett’s esophagus and esophageal cancers.

The Center’s team includes surgeons, gastroenterologists, interventional endoscopists, oncologists, pulmonologists, pathologists, and specially trained registered nurses.

Research/Clinical Trials

All patients are regularly followed to assess long-term results. We maintain data on patients’ progress in a database. By tracking patients’ results over the long term, we can perform studies on clinical outcomes to verify the efficacy and durability of interventions. Results are reported regularly in scientific journals so that the medical community and patients can be aware of the alternatives, benefits and risks of each procedure.