Achalasia

Treating Achalasia

How is it treated?

Medication

The muscle at the lower end of your gullet may be temporarily relaxed by medication. Tablets such as nitrates or nifedipine can sometimes produce a brief improvement in swallowing but are not effective in all patients. They can be helpful while a more permanent treatment is planned.

These tablets may cause headaches,but this usually improves with continued treatment.

Dilatation (stretching the muscle)

This is done under a sedative or general anaesthetic (where you are put to sleep). A balloon (about 3-4cm in diameter) is used to stretch and disrupt the muscle fibres of the sphincter muscle at the lower end of your gullet.

This usually improves swallowing butmay need to be performed several times or repeated after one or more years. Balloon dilatation does carry the risk of oesophageal rupture which may require emergency surgery.

Botulinum toxin (Botox injection)

Botox causes relaxation of the muscle fibres. It can be injected painlessly into the lower oesophageal sphincter muscle through an endoscope.

This is usually effective for a few months and occasionally for a few years, but has to be repeated. Botoxcan be used for temporary relief in people who are not able to haveother treatments.

Surgery

Under general anaesthetic the gulletis accessed through the abdomen (tummy) or, rarely, the chest. The muscle fibres of the lower oesophageal sphincter that fail to relax are divided. This usually leads to a permanent improvement in swallowing.

The operation is now performed by keyhole surgery ( laparoscopy )and only requiresan overnight stay in hospital.

Medically Reviewed by a doctor on 18 Jan 2018

Articles for achalasia

Myths and facts about achalasia

Here are some myths and facts about achalasia

Introduction

Achalasia is a disorder of the gullet (oesophagus) where it loses the ability to move food along. The valve at the end of the gullet also fails to open and allow food to pass into your stomach. As a result, food gets stuck in your gullet and is often brought back up.

What are the symptoms?

Causes of Achalasia

Achalasia is caused by damage to and loss of the nerves in the gullet wall. The reason for this is unknown, although a viral infection earlier in life may be partly responsible. Achalasia may also be associated with having an autoimmune condition, where the immune system attacks healthy cells, tissue and organs. One recent study found people with achalasiaare significantly more likely to have an autoimmune conditionsuch as Sjogren's syndrome , lupus or uveitis .

Diagnosing Achalasia

If your GP thinks you have achalasia, you will be referred to hospital to have some diagnostic tests performed. Barium swallow: A barium swallowinvolves drinking a white liquid containing the chemical barium, which allows the gullet to be seen and videoed on an X-ray. Endoscopy: A flexible instrument called an endoscope is passed down your throat to allow the doctor to look directly at the lining of your gullet and stomach. Trapped food will be visible.

Treating Achalasia

The aim of treatment is to open the lower oesophageal sphincter muscle so food can pass into the stomach easily. The underlying disease cannot be cured but there are various ways to relieve symptoms which can improve swallowing and eating. The muscle at the lower end of your gullet may be temporarily relaxed by medication. If heartburn develops aftertreatment, consult your GP as medication may be needed to reduce the acid reflux.

Recovery from treatment

There are a few things you can do after dilatation or surgery to reduce symptoms: chew your food well, take your time eating, drink plenty of fluids with your meals, always eat food sitting upright, use several pillows or raise the head of your bed so that you sleep fairly upright, which prevents stomach acid rising into your gullet through the weakened valve and causing heartburn. If heartburn develops aftertreatment, consult your GP as medication may be needed to reduce the acid reflux.