Achalasia

Achalasia is a rare oesophageal disorder that is broadly characterized by the failure of lower oesophageal sphincter to relax in addition to the absence or abnormal contraction of the oesophagus. Dysphagia (swallowing difficulty) can be the most common symptom, although many patients may present with other complaints – mimicking reflux, chest pains and un-explained weight loss. Patients generally present in the younger years, whereby weight loss is a dominant issue. Only in hindsight, dysphagia had been an under-reported problem.

Diagnosing achalasia

• Endoscopy to rule out causes that can mimic achalasia
• Barium swallow
• Manometry (helps to differentiate the sub-types of achalasia)

What are the consequences of Achalasia?

We do not know the underlying causative reason. However as the disease progresses, the oesophagus can increase in size and become floppy. Hence food and fluid can stay stagnant for many hours and days. This may lead to bad breath. Patients with achalasia are more predisposed to cancers of the oesophagus. This tends to be the squamous type cancers. The incidence of developing cancer (squamous cell carcinoma) is small but the relative risk compared to the normal population is increased.

What are the treatment options?

• Medication
  Calcium channel blockers & nitrates. This has a generally poor result
• Botox injections
  Reasonable results but effects wear off in 3-6 months. Its use can be diagnostic and may help in patients who are not fit for surgery.
• Pneumatic dilatations
  This stretches and tears the lower oesophageal muscle. To date, the longevity of these results do not measure up against surgery.
• Surgery
  Heller’s Myotomy with or without an anti-reflux procedure.
• POEM
  Per Oral Endoscopic Myotomy. This is similar to a Heller’s Myotomy, except done via a gastroscope through the mouth. This is a relatively new procedure with similar results to a Heller’s Myotomy