Achalasia is an esophageal motility disorder that makes it difficult to swallow food or drink. This is a relatively uncommon disease where the esophagus is both unable to move food down to the stomach (impaired peristalsis) and the sphincter that connects the esophagus with the stomach (the lower esophageal sphincter) is unable to relax. These issues combined may cause food to feel like it is “stuck” in the esophagus, among other symptoms described below.
Signs and symptoms of achalasia include:
- Difficulty swallowing (dysphagia)
- Mild, intermittent chest pain
- Cough, especially at night
- Food regurgitation
Achalasia is often misdiagnosed when symptoms initially present, and thus surgical interventions can be delayed. Our service offers a robust foregut program where we offer multiple diagnostic and surgical interventions for patients with achalasia. Our endoscopy suite is fully equipped to perform various diagnostic testing for evaluation of esophageal function.
Upper endoscopy (EGD) with or without biopsy
This is a procedure where the surgeon uses an endoscope to visualize the structures of the upper GI tract. When the area of concern is seen, a biopsy may be taken and sent for pathology.
Bravo reflux capsule (pH testing)
Via upper endoscopy, our surgeons will attach a miniature pH capsule (aka the Bravo reflux capsule) into your esophagus to allow for ongoing monitoring of the pH of your esophagus over a 48-96 hour period.
High resolution Manometry
This test is performed in the endoscopy suite with specially trained nurses who insert a special catheter via the nose that will assess esophageal pressures, movement (peristalsis) and food movement down the esophagus with a series of swallows.
Peroral Endoscopic Myotomy (POEM)
In extreme cases of achalasia, or in cases where achalasia was not treated for a long period of time, we may recommend removal of the damaged portion of the esophagus by performing an esophagogastrectomy. This complex surgery requires removing a portion of the stomach and partial or complete removal of the esophagus with complex reconstruction. Traditionally, this surgery is performed via open laparotomy for the “abdominal part” of the surgery and thoracotomy for the “chest portion” of the surgery. Our service offers minimally invasive esophagogastrectomy (MIE) where both portions of the surgery are performed with key-hole incisions with improved surgical outcomes.An open thoracotomy is an invasive surgical approach where the surgeon may make one or more large incisions through the chest wall to access the area(s) of concern.