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Achalasia - Causes & Treatment

Achalasia is a rare motility disorder of the smooth muscle of the esophagus. It is characterized by spastic contractions of the esophagus and unpredictable relaxation of the sphincter between the esophagus and stomach. In people with achalasia, the nerve cells in the lower esophagus tube and the lower esophageal sphincter (LES) do not work correctly. The LES is responsible for allowing food to easily pass through esophagus while swallowing and to prevent the "back flow" (or reflux) of stomach contents back into the esophagus.

Achalasia affects roughly one in every 100,000 people. The esophagus is the "tube" that carries food, liquids, and saliva from your mouth to your stomach. People with achalasia experience the motility disturbance in the muscles of the esophagus in the form of esophageal spasms. This disturbance is sensed as difficulty swallowing, regurgitation, the sensation of food getting stuck in throat or chest, and chest pain.

Causes of Acchalasia:

The cause of achalasia is unknown. Onset is most often seen either during adolescence or geriatric age.

Complications caused by achalasia include:

  • Absent coordinated peristaltic (muscular) activity in the esophagus
  • Unpredictable relaxation of the LES
  • Failure of the LES to open completely

Medical and Endoscopic Treatment of Achalasia

While there is no proven medical treatment for achalasia, temporary relief is found through the use of botulinum Toxin A (Botox TM) injections. This leads to temporary relief of months duration. Botox TM is not thought to be curative in its application. Pneumatic balloon dilation provides more permanent relief. Candidates for this have to be carefully chosen. For example, pneumatic balloon dilation cannot be undertaken in patients with a notable hiatal hernia. Calcium channel blockers, nitrates, or phoshpodiesterase 5 inhibitor may help since they affect the contraction of smooth muscle.

Definitive Treatment:

Heller myotomy is the surgical procedure to treat achalasia. With Heller myotomy, the transverse muscle fibers around the gastroesophageal junction must be cut to limit their ability to block the passage of food. This "myotomy" defunctionalizes the LES. To limit gastroesophageal reflux after myotomy, it has become common practice to add a concomitant anterior fundoplication to limit reflux after myotomy.

"Conventional" laparoscopic Heller myotomy is a surgical approach to treat achalasia through several small incisions using laparoscopic instruments. Laparoscopic Heller myotomy is encouraged for symptomatic achalasia and is efficacious even after failures of dilation or Botox.

Approach: Laparo-Endoscopic Single Site (LESS) surgery:

LESS Heller myotomy involves the same surgical plan, in general, as conventional laparoscopic Heller myotomy, but with only one incision at the belly-button. When the operation is over, there is only one scar, and it is hidden in the umbilicus (i.e., the belly button). LESS surgery promises improved cosmesis, quick recovery, reduced pain, and shorter length of hospital stay. Most of all, after LESS Heller myotomy and anterior fundoplication, there is "no scar"

Since April 2008 we have undertaken over 140 Laparo-Endoscopic Single Site (LESS) Heller myotomies. Dr. Rosemurgy and Dr. Ross are believed to have the world's largest experience in treating achalasia with Heller myotomy. They pioneered the LESS surgery approach for achalasia. Both Drs Ross and Rosemurgy have presented and written on this approach and on achalasia widely. They work with a team of skillful and experienced colleagues.

LESS Heller myotomy with anterior fundoplication well palliates symptoms of achalasia and provides safe and cosmetically superior outcomes relative to conventional laparoscopy with no apparent scar. LESS Heller myotomy with anterior fundoplication is superior to Botox TM injections and is superior to balloon / bag dilation. LESS Heller myotomy with anterior fundoplication is encouraged for symptomatic achalasia and is efficacious even after failures of dilation or Botox.

What to expect after an operation for achalasia:

Some patients but not all experience one or more of the listed symptoms below:

  1. Shoulder pain last from 1-3 days after surgery. The pain is related to CO 2 insufflation necessary for laparoscopic operations. The CO 2 irritates the diaphragm which in turn sends referred pain to the shoulders. The shoulders are not injured. The more active you are after surgery (i.e. walking and staying out of bed) the quicker the pain is going to resolve.
  2. Difficulty swallowing solid food for 1-5 days. After surgery you may experience swelling at the end of your esophagus beginning of your stomach, where the muscle of the sphincter was divided. This swelling is normal! We will instruct you to be on a thick liquid diet (i.e. milk base liquids: yogurt etc.) for the first 2 weeks. After 2 weeks, you will advance your diet slowly to a regular diet.
  3. Nausea and/or vomiting may occur after surgery for 1-2 days. This is usually related to general anesthesia administered during the operation.
  4. Discomfort at the belly button for 1-7 days. We use the belly button to access the surgical site with very small instruments and a scope. Some level of discomfort is normal. If, however, you notice the belly button to have redness, hot to the touch, discharge, increased pain, and/or fever, please call my office or come to our emergency room.
  5. Discomfort below the sternum for 1-7 days. This is the location of the operation inside your abdomen. It is normal to feel discomfort for several days.


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Sharona Ross, M.D. - Tampa Laparoscopic Surgeon
Located at 3000 Medical Park Dr, Suite 500 Tampa, FL 33613. View Map
Phone: (813) 615-7030