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Learning About Achalasia

Esophagus, with detail of normal esophagus and one with a wide lower section from achalasia

What is achalasia?

Achalasia (say "ay-kuh-LAY-zhuh") is a problem with the nerves that control the muscles in the esophagus, the tube that carries food and liquid to your stomach. The muscles may tighten or spasm. The muscle that connects the lower end of the esophagus to the stomach may not open and close the right way.

Doctors aren't always sure what causes achalasia. It may be a problem with the nerves in your esophagus. Or it may be something you were born with.

What happens when you have achalasia?

When you have achalasia, you may have trouble swallowing foods and drinks. You may spit up (regurgitate) food. That means undigested food may come back up into your mouth. You may also have heartburn or pain in your chest.

These symptoms may cause you to lose weight. There's also a risk that you could inhale food or liquid into your lungs (aspiration). That may lead to pneumonia.

How is achalasia treated?

Medicines, such as nitroglycerin or calcium channel blockers, can help relax the muscles in your esophagus for a while.

You may need a procedure called esophageal dilation.

During the procedure, you will get medicines through a needle in a vein (IV) in your arm or hand. These medicines reduce pain and will make you feel relaxed and drowsy. Your throat will also be numbed. You may not remember much about the treatment.

The doctor will guide a balloon or a plastic tool (dilator) down your throat and into your esophagus. The dilator is used to widen any narrow area.

To guide the dilator, the doctor may use a tool called an endoscope, or scope. It's a thin, flexible, lighted viewing tool. It goes into your mouth and down your throat. Or the doctor may use a thin wire as a guide.

Some people have surgery for achalasia. You will have general anesthesia so that you are completely unaware and won't feel pain during the surgery. Surgeries include:

Heller myotomy.

In this surgery, the doctor makes small cuts on the muscles inside the esophagus. This allows the opening to the stomach to relax so that food and drinks can pass through. It can be done through a thin tube that is placed in a small cut in the belly. Sometimes it's done through a larger cut (incision). You will stay in the hospital for 1 or 2 days after the surgery.

Peroral endoscopic myotomy (POEM).

This surgery also involves making small cuts on the muscles. But it's done through a scope that goes in through the mouth. You will stay in the hospital for a day after the surgery.

Achalasia may also be treated with a botulinum toxin A (Botox) injection. Botox is injected into the muscle near the opening to the stomach through a scope. It helps the muscle relax. You may need another shot of Botox after 6 months or a year.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

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