Achalasia. The name evokes a flower, or something sweet, but it is actually drawn from ancient greek— khalsis, a loosening. The Prefix “A-” negates that. So the word itself is quite descriptive, meaning, simply, an inability to loosen. Loosen what, exactly? In the most basic terms, one’s throat: Achalasia is an inability to swallow solids and liquids. For those searching for a more precise picture, it takes place in the muscular layer of the lower esophagus, where it empties into the stomach. The disorder causes these muscles fail to relax during swallowing. This is caused in part by a lack of peristalsis, normal esophageal waves which help with swallowing, making it difficult to pass the food bolus into the stomach.
As for who should be interested, this disease affects adults, mostly. Especially those in their 30s through their 50s (although I have seen it in younger patients). Unfortunately, little is known about whether there are any direct genetic or lifestyle causes for Achalasia. It is believed that anyone can develop it. However, it is a rare disorder, occurring only in one to two per two hundred thousand people.
The main symptoms of this disorder include a progressive difficulty swallowing that often leads to a choking sensation, regurgitation, the spitting up of undigested food, heartburn, chest pain behind the breast bone, and weight loss. This can lead to a number of health hazards including: malnutrition, pneumonia, and the risk of aspirating food, liquids, saliva, and other stomach contents.
The treatment is often a multi-specialty approach, in which patients are usually started on medications that help relax the esophagus. Often, however, medications alone are not enough, and endoscopic dilation is then implemented. The gold standard therapy is a minimally invasive approach where the defective fibers around the esophagus are individually divided in order to allow complete relaxation of the esophagus and a resolution of the swallowing difficulties. This surgical procedure is called a Heller Myotomy, and it has a success rate greater than ninety percent.
Truth is, when treated correctly by an experienced surgeon, patients tend to do very well— having more than 90 percent resolution. However, that isn’t exactly a call to rejoice. Treatment can often become challenging when patients seek help late in diagnosis, and their esophagus is at the point where it no longer works.
Other similar situations include patients who have already undergone other treatment modalities, such as botox injections, which have failed. These patients tend to be placed at higher subsequent surgical risks.
As for how I usually come across Achalasia, this is such a rare disorder that patients are typically referred to me by GI Specialists, Primary Care Providers, and other Surgeons in the community. But, occasionally I will have a patient who shows up to the office with these symptoms. If you feel that you have been bothered by a number of them, then please do not hesitate to make an appointment and have it checked out. Remember, it has a high rate of resolution, but the longer you wait, the more likely it is to become a problem.
Ángel Tamez, MD
General Surgery, Bariatric
A native of the Rio Grande Valley, Dr. Tamez obtained his medical degree at the University of Texas Health Science Center in San Antonio. Upon completion of his surgical residency at Loma Linda University Medical Center in California, Dr. Tamez obtained fellowship training in Minimally Invasive Surgery & Bariatrics at Wake Forest University Medical Center in North Carolina. Dr. Tamez specializes in General Surgery using the latest minimally invasive techniques promoting faster recovery times and the best results.
My goal is to provide the best medical care available to my patients with compassion.