Ernesto Escobar, MDAchalasia is an esophageal motility disorder characterized by the inability to pass food from the esophagus into the stomach, leading to malnutrition and the sensation of food “getting stuck” in the chest.
Under normal conditions, the esophagus performs movements (peristalsis) to transport food from the mouth to the stomach, preventing food from descending solely by “gravity.” At the junction between the esophagus and the stomach, there is a muscular thickening of the esophagus known as the Lower Esophageal Sphincter (LES).
Normally, the Lower Esophageal Sphincter relaxes to allow food to pass from the esophagus into the stomach and contracts to prevent acid reflux back into the esophagus. When the sphincter remains contracted and with increased tone, failing to relax to allow the passage of food, this is known as Achalasia (derived from Greek meaning “lack of relaxation”).
Symptoms
At the beginning, progressive intolerance to food occurs—typically to solids—which later progresses to intolerance to liquids, accompanied by the following:
In general, symptoms of achalasia develop gradually and worsen over time. Symptoms may include:
Dysphagia, which is difficulty swallowing; it may feel as though food or liquids are stuck in the throat.
Food or swallowed saliva returning back into the throat.
Heartburn.
Belching.
Chest pain that comes and goes.
Nighttime coughing.
Pneumonia due to aspiration of food into the lungs.
Weight loss.
Vomiting.
A key aspect of this disease is that its origin is unknown and there is no anatomical cause (tumors, hernias, radiation, etc.). However, it is believed that conditions affecting the nerves of the sphincter may be involved (past viral infections, genetic factors, autoimmune mechanisms) and contribute to the development of this condition.
When symptoms similar to those of Achalasia are caused by another anatomical condition, this is known as Pseudoachalasia (false achalasia).
Treatment
Treatment for achalasia consists of performing Heller Myotomy, which involves cutting the muscle fibers of the esophagus so that the sphincter relaxes and allows food to pass. This is usually combined with an antireflux procedure (fundoplication).
This surgery is performed laparoscopically, which allows for faster recovery and less postoperative pain compared to conventional open surgery. With this procedure, we restore our patients’ quality of life and improve their nutritional status.