What is achalasia?
Achalasia is a rare and progressive disorder of the esophagus that impairs the ability to swallow. Achalasia is characterized by abnormal enlargement of the esophagus, an inability of the esophagus to push food down toward the stomach (peristalsis), and failure of the ring shaped muscle (the lower-esophageal sphincter) to relax and allow food to pass into the stomach.
What causes achalasia?
The causes of achalasia are not known.
What are the symptoms of achalasia?
The symptoms of achalasia can be apparent in infants, or gradually appear in childhood or adulthood. The most common symptoms are:
- difficulty swallowing liquids or solids
- chest pain
- regurgitation of swallowed foods and liquids
- difficulty burping
- sensation of a lump in the throat
- weight loss
How is achalasia diagnosed?
Achalasia is diagnosed using a number of tests:
- chest X-rays - these simple exams can show distortion of the esophagus, which can indicate achalasia.
- barium swallow test - this procedure involves swallowing a substance called barium while X-rays are taken.
- manometry - this procedure is the definitive test to establish the diagnosis of achalasia. A thin tube is placed through the nose or mouth into the esophagus to measure the pressure within the esophagus and the lower esophageal sphincter.
- endoscopy - this procedure involves the use of a thin and lighted tube placed through the nose or mouth into the esophagus to "see" inside the esophagus.
- CT scan - this procedure can provide further visual evidence to establish the diagnosis of achalasia.
How is achalasia treated?
The treatment of choice for the condition is a surgical procedure known as a Heller myotomy, in which the muscles surrounding the esophagus and the lower esophageal sphincter are cut to allow food and liquids to pass to the stomach more readily. The procedure can be performed using traditional open surgery methods, which require a large incision, or using laparascopic surgical techniques, which reduce the size of the incision, cause less pain, and reduce recovery time. At Boston Children's Hospital, Heller myotomy procedures can be performed using robotic surgery equipment, allowing patients the benefits of minimally invasive surgery and improving surgical precision.
The surgery does not cure achalasia, but it does provide most patients significant long-term relief of their symptoms.
What is the long-term outlook for a child with achalasia?
While there is no cure for the condition, surgical intervention can allow most people with achalasia to live normal lives.