Oesophageal Achalasia Surgery in Sydney
What is Achalasia?
Achalasia is an uncommon condition of the oesophagus that leads to swallowing difficulties. In achalasia, nerve endings in the oesophagus are damaged, and coordination of oesophageal muscles is affected. This results in a widened oesophagus, and tight lower oesophageal sphincter, so that food is not easily squeezed down into the stomach.
What causes achalasia?
The cause of achalasia is unknown. Researchers suspect that a viral infection or autoimmune condition may be responsible for oesophageal nerve damage. Achalasia most often affects adults between the ages of 25 and 60, but can occur at any age.
What are the symptoms of achalasia?
Achalasia symptoms tend to develop gradually and worsen over time. The most common symptom is difficulty in swallowing. It could feel like food or liquids are “stuck in your throat”. Achalasia may lead to vomiting and dehydration, or weight loss and malnutrition.
Achalasia could cause symptoms of GERD (add link to “GERD”), like heartburn and regurgitation. It could also result in coughing at night, or pneumonia if regurgitated food particles reach the lungs.
How is achalasia diagnosed?
Achalasia can sometimes be overlooked, as it has similar symptoms to other gastrointestinal conditions.
The following investigations could help your specialist to diagnose achalasia:
- Gastroscopy – During a gastroscopy, the specialist is able to visualize your upper gastrointestinal system, and take biopsies if needed. If you are experiencing difficulty in swallowing, it is important for the specialist to confirm that your symptoms are not caused by a blockage in your oesophagus, rather than achalasia.
- Oesophageal manometry – This test is the most useful for diagnosing achalasia. It measures the pressure in your oesophagus, and the motility of the oesophagus muscles during swallowing.
- Contrast swallow test – During this test, you are given a liquid contrast medium to drink. X-rays are taken, and the contrast highlights the shape of your oesophagus and stomach.
- CT scan – This is more detailed than a conventional x-ray and may be required in some cases.
How is achalasia treated?
In most cases, achalasia is treated surgically.
During a laparoscopic Heller’s cardiomyotomy, the surgeon makes an incision in the outer muscles of the lower oesophagus and upper stomach, via keyhole surgery. This well-known procedure has been safely performed for decades, and relieves the symptoms of achalasia by allowing food to pass more easily into the stomach. The procedure is usually combined with a partial fundoplication, which involves wrapping the top of the stomach around the lower part of the oesophagus. This is done to prevent reflux (GERD) following surgery.
Alternatively, achalasia is treated with a Peroral endoscopic myotomy (POEM). During this procedure, the specialist reaches the inside of the oesophagus from your mouth, by using an endoscope. From inside the oesophagus, the surgeon makes a cut in the lining of your oesophagus and lower oesophageal sphincter.
In some cases, where a patient’s general health makes surgery an undesirable option, achalasia can be treated by a simpler procedure known as Oesophageal dilatation. Oesophageal dilatation, or widening, is less invasive than surgery. However, it is also less effective.
