What is Achalasia?
Achalasia of the cardia (commonly called Achalasia) is an oesophageal (gullet) motility disorder. There are two oesophageal sphincters. One is in the throat at the top end of the gullet. Second on is at the bottom end of the gullet where it joins stomach. The purpose of this valve is to allow food and drink in one direction i.e., into the stomach. Weak lower oesophageal sphincter results in reflux.
In achalasia, there is incomplete or total lack of relaxation of the lower sphincter. This is due to the lack of nerves extending into the sphincter signalling it to relax. The most common form of Achalasia is ‘Primary Achalasia’, where the cause is not known. ‘Secondary Achalasia’ could be due to gullet cancer or following an infection called Chagas Disease (common in South America).
What are the symptoms?
Patients with achalasia find it difficult to swallow and feel food sticking at the bottom of the chest or the top of the stomach. The difficulty in swallowing (dysphagia) is progressive. Initially the difficulty is with solid food, but can progress to difficulty with liquids and sometimes to total dysphagia. Patients can also present regurgitation of food. Typically, patients regurgitate food that they have eaten a few days ago. Achalasia can also cause chest pain.
Achalasia is diagnosed by means of an endoscopy (oesophago-gastric & duodenoscopy – OGD), barium swallow. To confirm the diagnosis, all the patients require to have oesophageal manometry (pressure measurements of the gullet) and a 24hr pHmetry. They may also need to undergo a test called High Resolution Manometry (HRM).
Achalasia can be treated either endoscopically or by surgery. In patients who are unfit for a general anaesthetic, endoscopic procedures such as dilatation or botox injection into the lower oesophageal sphincter is preferable. However, these procedures may require repeated attempts.
In patients who are fit for surgery, this operation can be performed either laparoscopically (keyhole) or using a robot. During the operation, front part of the oesophagus is dissected. Muscle is divided down to the mucosa (inner lining of the stomach and gullet) starting about 2cm on the stomach side of the gastro-oesophageal junction (junction of the gullet and stomach) and extended to about 5cm onto the oesophageal side. Therefore a total muscle cut of 7cm is achieved. Care is taken not to make a hole in the mucosa. In some patients, an anti-reflux procedure may be required to prevent any reflux (due to weakened lower oesophageal sphincter).
Mr Jayanthi can perform endoscopic, laparoscopic (keyhole) & robotic procedures. Following the confirmation of the diagnosis, all the options will be discussed with the patient.