National Leaders in Minimally Invasive Thoracic Surgery


Achalasia and Heller Myotomy

What is Achalasia?
Achalasia is a rare disease of the esophagus where a person loses the normal ability to swallow food. The name means a “failure to relax” and refers specifically to the lower esophageal sphincter muscle (or where the lower esophagus meets the stomach.)

How is Achalasia diagnosed?
Achalasia can easily be confused with other conditions; therefore, any person noticing a persistent and consistent inability to swallow food or liquid and/or feeling a sense of food “sticking” in their chest should consult their doctor immediately. Loss of appetite, vomiting, chest pain and weight loss are all common warning signs of the disease. In severe cases of untreated achalasia “aspiration pneumonia” (or an inflammation of the lungs and airways) can arise due to trapped food in the esophagus which increases breathing difficulties.

Early diagnosis and treatment are essential to stop damage to the esophagus and restore normal eating and digestion. The most important key to properly diagnosing achalasia is a person’s medical history. It is advisable for you to keep and present your doctor with a detailed record of when you have difficulty swallowing food and other symptoms over an extended period of time.

After an initial exam, your doctor may take a video x-ray of your upper and lower digestive system.

Another test is an esophageal manometry (or a pressure test) which uses a thin tube passed through the nose to measure the ability or failure of the lower esophageal muscle to properly contract.

“Endoscopy” is another way to diagnose achalasia. It involves the patient swallowing a small camera with a light attached so doctors may actually see the condition of the esophageal muscles. From this “picture” they can determine if your symptoms are being caused by cancer or some other disease known to mimic the signs of achalasia.

How do we treat achalasia?
Treatments for achalasia range from oral and injected medications to physical stimulation and stretching of the esophagus to surgery. Each procedure has differing success rates and risks but all are designed to relieve the pressure within the lower esophageal sphincter muscle allowing food to pass into the stomach.

If the condition is serious, surgery may be the best treatment. Surgeons may recommend an “esophagomyotomy” (or surgical incision into the muscular tissue of the esophagus). A thoracic surgeon will conduct this procedure sometimes called Heller Myotomy, named for Ernst Heller a German physician who first performed it in 1913. The procedure is done robotically (using small or keyhole incisions in the chest) offering a quicker recovery rate and less post-surgical complications. After surgery doctors may also recommend medications to help prevent the occurrence of acid reflux or other ailments.

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