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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 conditions of the esophagus.

About Achalasia

Achalasia is a disorder of the esophagus that makes it difficult to swallow solid foods or liquids. 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. Achalasia occurs when the esophageal sphincter muscle (located between the esophagus and the stomach) doesn’t relax as much as it should, making it hard for food to pass from the esophagus into the stomach. The cause of this disease is not known.

Achalasia is a rare disorder — only about 2,000 people in the U.S. are diagnosed with it 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.

Symptoms

Achalasia is one of several types of esophageal motility disorders. The most common symptom of achalasia is difficulty swallowing. This problem may last months or even years before a person seeks help. Other symptoms can 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 UChicago Medicine 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 see inside the esophagus and other organs. This test is important to make sure cancer is not present.
  • Manometry. A manometry study measures the strength and coordination of the muscles in the esophagus and evaluates the function and relaxation of the valve (lower esophageal sphincter) located between the esophagus and the stomach. During the procedure, a very thin tube is passed through the nose and down to the stomach to examine esophageal muscle function.

Treatments

UChicago Medicine offers several treatment options for achalasia, including:

Laparoscopic esophageal myotomy. A minimally invasive surgical procedure to decrease the pressure of the lower esophageal sphincter muscle and make it easier to swallow. Working through several small incisions, the surgeon severs muscles of the valve located between the esophagus and stomach, making it easier for food to pass through.

Peroral endoscopic myotomy (POEM). An incisionless surgical procedure performed by a specialist in interventional endoscopy. After placing a flexible scope through the mouth and into the patient’s esophagus, the physician creates a tunnel between the layers of the esophagus to reach the lower sphincter muscle. The muscles are then cut, permanently opening the valve.

Endoscopic dilation. A procedure to widen the lower esophagus.

Botulin toxin (Botox) injections. Botox injections to paralyze the sphincter muscle and prevent muscle spasms.

Oral medications are not effective for treating achalasia.

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 effectiveness 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.