Achalasia​

Achalasia is a disorder that affects your oesophagus (the tube which transports food from your mouth to your stomach). 

The LOS (Lower Oesophageal Sphincter) is a muscular ring located between where your lower oesophagus and stomach meet, which opens to enable food to pass into your stomach. The achalasia disorder causes damage to the nerves of your oesophagus or to your LOS. This impacts the LOS and causes it to not relax (open) as normal while swallowing, impacting the ability of your oesophagus to carry food to your stomach. Additionally, the disorder causes the usual muscle activity of your oesophagus (peristalsis) to decrease (or stop). This activity normally coordinates the muscle activity in the body of your oesophagus to move food from your throat to your stomach.   

Although achalasia is rare, it can occur at any age. However, it is most common amongst middle-age to older adults. This disorder may be an inherited disorder in some individuals, or due to an autoimmune condition which causes the degeneration of nerves in your oesophagus (e.g. cancer or Chagas’ disease).  

Although there are non-surgical options to treat achalasia, in some instances surgery may be the best option. The GI and Surgery Service Line at The Aga Khan University Hospital can provide you with surgical options to treat achalasia.  

Symptoms of achalasia include:

  • Regurgitation (backflow) of food. This raises the risk of aspiration or choking on food.
  • Sharp pain in your chest, which may worsen after eating. This may be felt in you back, neck or arms too.
  • Cough 
  • Trouble with swallowing both solids and liquids (dysphagia)
  • Unintended weight loss
  • Heartburn
You sh​​ould visit your doctor at the GI and Surgery Service Line at The Aga Khan University Hospital if you notice any of the symptoms of achalasia, such as difficulty with swallowing (foods and liquids) or pain in your chest. Early treatment can prevent oesophageal dilation to worsening to a point where there are serious health complications. 
Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.
When you visit a doctor with symptoms resembling those of achalasia, they will usually already suspect that you have this disorder. The will ask you to describe your symptoms in detail and assess the history of the symptoms, for instance the progressive difficulty in swallowing over a period of time.  That may also take note of other symptoms such as weight loss (if any), chest pain, or regurgitation of food. Further tests to help diagnose achalasia (and show signs of anaemia or malnutrition) include:

  • Oesophageal manometry – this will examine the pressure inside the lower part of your oesophagus.

  • Endoscopy – this can be helpful in diagnosing other causes for these symptoms. 

  • Barium swallow – this will help to track the movement of barium down your oesophagus through X-rays.  ​

There are various forms of treatment for achalasia, all aimed at reducing the pressure in your lower oesophagus and allowing an easier passage of food from your oesophagus to your stomach. Speak to your doctor about which form or treatment is most appropriate and would be most beneficial for your personal situation. 

Non-surgical surgical options for achalasia include:

  • Botulinum injection (Botox) – this may help your sphincter muscles to relax. However the effects are temporary and will wear off after a few weeks or months.
  • Medication – medication may help to relax the lower part of your oesophagus sphincter, such as long-acting nitrates or calcium channel blockers.
  • Endoscopic Dilation – this aims to widen (dilate) your oesophagus where it is narrow. This may sometime be performed during the surgical procedure for achalasia.  

In some instances, a surgery is required to decrease the pressure in the lower part of your oesophageal sphincter.

The surgical treatment for achalasia is usually a Heller myotomy, which is a procedure where a small incisions is made to access your and make cuts in your LOS in order to make it easier to swallow and allow food and liquid to pass to your stomach. This surgery may be performed open or laparoscopically. Both types of surgery have advantages and disadvantages. Your doctor can help you choosing better treatment option for you depending on your condition.

Please click here for some guidelines on “what to do before your surgery”
Please click here for some guidelines on “what to do on the day of your surgery”​
As with any surgical procedure, there is some level of risk involved. Potential risks and complications associated to a Heller myotomy include:

  • Problems associated with anaesthesia - such as pain, bloating, gas or diarrhoea. 

  • Postoperative bleeding 

  • Oesophageal or gastric injury

  • Damage to internal organs (e.g. lung, spleen, oesophagus or liver) which is a rare complication

Please click here for some guidelines on "what to do after your surgery"​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage.​


 


 


 

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.