ACHALASIA SURGERY

What is Achalasia Surgery?

Achalasia is a rare disorder. It makes food and liquid difficult to pass from the swallowing tube that connects the mouth with (esophagus) into the stomach.

Achalasia is due to damaged esophagus nerves; the esophagus becomes paralyzed and dilated over time. It loses its ability to move food down to the stomach due to which Food remains in the esophagus, tends to ferment, and going back up into the mouth with a bitter taste. 

The peoples mistook this as gastro esophageal reflux disease (GERD), but in achalasia, the food comes from the esophagus, whereas it comes from GERD’s stomach.

Certain surgeries manage the symptoms of achalasia like there is some minimally invasive procedure to treat this.

The exact cause of achalasia is still unknown. Researchers say that it may be due to a loss of nerve cells in the esophagus. Viral infection or autoimmune responses have also been suspected of causing achalasia. Achalasia might be an inherited genetic disorder or disease.

Symptoms

The symptoms generally appear and worsen over time, including heartburn, belching, regurgitation of food, swallowing difficulty, chest pain, weight loss, vomiting, pneumonia, and coughing at night.

Treatment

Achalasia treatment generally focuses on relaxing or stretching the lower esophageal sphincter so that food and liquid can move quickly through the digestive tract.

Nonsurgical treatment

· Pneumatic dilation. In this treatment, a balloon is inserted into the esophageal sphincter by endoscopy to inflate the opening. This outpatient procedure often needs to be repeated if the esophageal sphincter doesn’t remain open. The treatment is repeated more or less after five years.

· Botox (botulinum toxin type A). Botulin is a muscle relaxant injected directly into the esophageal sphincter with the help of an endoscopic needle. This needs to be injected repeatedly, which makes it challenging to perform the surgery later if needed. Botox is recommended only for people who aren’t eligible candidates for pneumatic dilation due to age or overall health condition. Botox injections last for about six months. A significant improvement from the injection of Botox may help confirm a diagnosis of achalasia.

· Medication. Nitroglycerin (Nitrostat) or nifedipine (Procardia) may be recommended before eating. These medications offer limited treatment and have severe side effects. Medications are generally recommended only if you’re not a potential candidate for pneumatic dilation or surgery, 

Surgery

Surgical options for treating achalasia are as follows:

· Heller myotomy. During this, the surgeon will cut the muscle at the lower esophageal sphincter to allow the food to pass more quickly. The procedure is non-invasive, can be done by using a laparoscope. Patients who have had Heller myotomy may have a possibility to develop GERD; to avoid this procedure; fundoplication is performed simultaneously with Heller myotomy.

· Perioral endoscopic myotomy (POEM). In this procedure, the surgeon will use an endoscope and insert it through the mouth to create an incision inside the esophageal lining. Then, the surgeon cuts the esophageal muscle at its lower end. POEM might be performed with or without fundoplication.