Achalasia: how to treat swallowing problems

Achalasia is a rare condition of the lower oesophageal body (also known as the gullet, or food pipe) that makes it difficult for food and liquid to pass into your stomach. The gullet is characterised by failure of peristalsis, a series of muscle contractions that move food through the digestive tract. There is also the failure of the sphincter at the bottom end of the gullet that is supposed to relax in response to swallowing.

Consultant surgeon Professor Muntzer Mughal explains more about the disorder, including the symptoms and treatment options.

What are the symptoms of achalasia?

The main symptom is difficulty with swallowing. This often comes on gradually over a period of months or years. Although there are other causes for difficulty in swallowing, the particular characteristic of achalasia is difficulty in swallowing both liquids and solids. Some forms of achalasia are also associated with chest pain.

How is achalasia diagnosed?

As the symptoms of achalasia develop gradually and it often presents in young people, investigations are often delayed. Furthermore, the most common investigation for difficulty with swallowing, endoscopy, will often fail to identify this condition. It therefore requires a high index of suspicion and when the diagnosis is suspected the patient requires oesophageal manometry to clinch it.

What is the best surgical treatment for achalasia?

The best surgical treatment for achalasia is keyhole surgery to divide the sphincter muscles and perform an operation called fundoplication to prevent reflux of acid which would otherwise occur from the cutting of the sphincter muscles.

There are other nonsurgical procedures for achalasia such as dilatation, which is the stretching of the sphincter through endoscopy.

There is a new procedure called POEM (Per Oral Endoscopic Myotomy), which also divides the muscles but endoscopically.

How common is achalasia?

It is difficult to be certain about the prevalence of achalasia because it often remains undiagnosed. However, it is estimated that it occurs in 1/100,000 people in the Western world.

Can achalasia lead to cancer?

Achalasia does lead to a slightly increased risk of cancer of the oesophagus, however, although there are no reliable figures for this risk it is extremely low.

If you're concerned about your problems in swallowing book an appointment with Professor Mughal now for a consultation.