What is Achalasia?
Achalasia is a rare but serious swallowing disorder that affects about one in every 100,000 people. Achalasia occurs when the nerves, cells and muscles in the lower esophagus (food pipe) stop working properly. Normally, the muscular ring at the lower end of the esophagus – the lower esophageal sphincter or LES – will open automatically to allow food to enter the stomach and then close to keep it there. In patients with achalasia, these muscles fail to open up during swallowing, making it difficult or impossible for food and liquid to enter the stomach.
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Achalasia is most often diagnosed in people between 25 and 60 years of age, however it can also occur in children. The most common symptoms include:
- Difficulty swallowing solid and liquid foods
- Bitter taste in the mouth due to food collecting in the esophagus and backing up into the mouth
- Intermittent chest pain that can range from mild to intense
- Weight loss
If you are experiencing any of these symptoms, it is important to seek professional medical advice. Untreated, achalasia can lead to:
- Aspiration pneumonia – caused when food or liquids back up in the esophagus and are inhaled into the lungs through the windpipe
- Weight loss and malnutrition
- Poor quality of life
What causes achalasia?
Although the exact cause of achalasia is unknown, some research suggests it may be an autoimmune disorder in which the body’s immune system attacks the cells of the esophagus. Other possible causes include infection or genetic factors.
How is achalasia diagnosed?
The digestive health experts at University Hospitals use the most advanced diagnostic tools available to confirm or rule out a diagnosis of achalasia. Procedures include:
- Imaging Tests such as ultrasound or X-ray will be used to help identify structural and functional problems in the esophagus.
- Nonsurgical Endoscopic Tests including esophageal manometry may be used to measure and evaluate muscle strength and contractions in the esophagus. If abnormalities are found in the lower esophageal sphincter, your doctor may confirm a diagnosis of achalasia.
- Endoscopy, Endoscopic Ultrasound & Biopsy. The digestive health experts are UH use minimally invasive techniques to sample tissue in the esophagus to assist in making a diagnosis.
UH Digestive Health Experts Offer Advanced Treatment for Achalasia
Achalasia is a chronic disease for which there is no cure. However, the digestive health experts at University Hospitals can help to manage your symptoms with certain lifestyle changes and minimally invasive therapies or surgery, including:
- Botulinum toxin injection
- Laparoscopic Heller Myotomy
- POEM – Per-Oral Endoscopic Myotomy
- Pneumatic Dilation
Although dietary changes may help to reduce symptoms, the most definitive treatment for achalasia is a relatively new, minimally invasive endoscopic procedure called Per-Oral Endoscopic Myotomy or POEM.
POEM: A Minimally Invasive Procedure to Treat Achalasia
POEM is an inpatient procedure that takes one to three hours to complete with the patient under general anesthesia. Once the patient is asleep, the doctor inserts a flexible tube with a light and camera attached to it into the mouth and down the esophagus. This allows the doctor to examine the inside of the esophagus without making any external incisions.
Using special surgical tools attached to the end of the endoscope, small incisions are made to cut away and loosen the tightened muscles that are causing the swallowing problems. Small clips are used to keep the incisions closed and the endoscope is then removed. This procedure allows the lower esophageal sphincter to open normally so that food can pass through to the stomach. Most patients will be kept in the hospital for an average of two days to receive intravenous antibiotics and have their recovery monitored by their care team.
The POEM procedure only recently became available in the United States and there are very few centers with more than 10 years of experience in only a handful of health care facilities with surgeons who have been trained in this advanced endoscopic technique. University Hospitals Digestive Health Institute is proud to offer patients this procedure, through Jeffrey Marks, MD, general surgeon and Director of Surgical Endoscopy at UH Cleveland Medical Center. Dr. Marks has been specially trained to perform POEM and further explains the procedure in this video.