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Achalasia

Achalasia - What it is

Achalasia is a rare condition that affects the oesophagus that connects the throat to the stomach. The nerves in the oesophagus no longer signals it to push food down into the stomach, and the valve at the end of the oesophagus (lower oesophageal sphincter) no longer opens during swallowing. As a result, ingested food cannot enter the stomach and collects in the oesophagus. It is a progressive disease that worsens over time and results in a higher risk of oesophageal cancer.

What causes achalasia?

The majority of achalasia cases are idiopathic (i.e. unknown cause). No one truly knows why the nerve cells in the oesophagus are affected, although it has been linked to virus infections or autoimmune disease (where the nerves are “attacked” by your own immune system).

Achalasia - Symptoms

The food that remains in the oesophagus can undergo fermentation and come back up into the mouth, resulting in a bitter taste. This is often mistaken for gastroesophageal reflux disease (GERD) but unlike GERD, the undigested food comes from the oesophagus and not from the stomach. The main symptoms are:

  1. Dysphagia (difficulty in swallowing) of both liquids and solids
  2. Regurgitation of undigested food
  3. Chest pain/discomfort
  4. Heartburn
  5. Loss of weight

Achalasia - How to prevent?

Achalasia - Causes and Risk Factors

Achalasia - Diagnosis

How is achalasia diagnosed?

Three tests are performed to diagnose achalasia. They are:

    (a) Endoscopy (oesophagogastroduodenoscopy)
  • A flexible scope is passed into the oesophagus to rule out other causes of dysphagia such as tumours/growths.
    (b) Barium swallow
  • A specialised x-ray of the passage of the swallowed barium down the oesophagus.
    (c) High resolution manometry
  • A test that measures the pressure, timing and contractions of the oesophagus as well as the lower oesophageal sphincter relaxation.
  • It helps to confirm and determine the subtype of achalasia.

Achalasia - Treatments

If left untreated, achalasia can result in severe weight loss due to malnutrition, and even recurrent lung infections due to aspiration of food. The main treatment options are:


A) Per oral endoscopic myotomy (POEM)
  • This is a newer endoscopic technique that cuts the lower oesophageal muscle fibres using the endoscope.
B) Surgical cardiomyotomy and fundoplication
  • This is performed via laparoscopic techniques (key-hole surgery) and involves cutting the lower oesophageal muscle fibres.
  • A fundoplication procedure (wrapping of the top part of the stomach around the lower oesophagus) may be added to minimise risk of reflux (GERD).

Second line treatment options may be recommended under certain circumstances (i.e. when the patient is not fit for general anaesthesia). These treatments include:


(a) Endoscopic balloon dilatation
  • This procedure is used to stretch or break the lower oesophageal sphincter muscle fibres.
  • The effect is temporary but longer-lasting compared to medication.
  • Repeated treatment is required

(b) Medications/Pharmacological therapy
  • Medication such as nitrate drugs or Botox is used to relax the lower oesophageal sphincter (LES) .
  • The treatment effect is temporary, and usually lasts about 6-12 months depending on the medication used.

(c) Surgical oesophagectomy (removal of the oesophagus)
  • This is reserved for patients with severe, end-stage achalasia where the oesophagus is very distended and filled with food

The type of treatment offered will depend on the type of achalasia. Our team of doctors will discuss for your treatment options in further detail with you.

Achalasia - Preparing for surgery

Achalasia - Post-surgery care

Achalasia - Other Information

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