Esophageal Diseases

Achalasia

Specialized care for difficult swallowing

Achalasia is a rare disorder that causes difficulty swallowing due to failure of the lower esophageal sphincter (the ring of muscle between the end of the esophagus and the stomach) to open or relax. At NewYork-Presbyterian, we have dedicated esophageal disorders programs offering comprehensive diagnostic testing and advanced endoscopic and surgical treatments to relieve your achalasia symptoms — restoring your ability to eat and drink comfortably and enhancing the quality of your life.

What causes achalasia?

In people with achalasia, there is a loss of nerve function in the muscle of the esophagus, but the cause is not known.

Signs & Symptoms of Achalasia

Symptoms of achalasia can include:

• Difficulty swallowing (dysphagia)
• The feeling that food is not going down to the stomach
• Regurgitation of undigested food
• Chest pain or heartburn

Advanced Diagnostic Testing

The diagnosis of achalasia requires specialized “motility testing” to see how well your esophagus is working to move food down toward your stomach. At NewYork-Presbyterian, our state-of-the-art motility labs use the latest techniques to determine the exact cause of your swallowing difficulty. Some of the techniques we use include:

• High-resolution esophageal manometry. This test measures the pressure, strength, and coordination of the muscles in your esophagus. A thin tube is passed through your nose and down into your stomach. We then measure esophageal muscle function while you swallow sips of liquid. Manometry assesses the function and relaxation of your lower esophageal sphincter.
• Endoscopy. Examination of your esophagus using a flexible tube with a camera at its tip.
• Endolumenal functional endoluminal imaging probe (Endoflip). This novel device evaluates the esophagus by determining its ability to open.
• Upper GI (gastrointestinal) series (also called a barium swallow) involves swallowing a liquid or tablet that can be seen on x-rays as it goes down your esophagus.

Our Approach to Care

A key feature of achalasia care at NewYork-Presbyterian is our team approach: surgeons and gastroenterologists use minimally invasive surgical and endoscopic techniques to treat this condition. Your healthcare team also includes motility experts to ensure you have the most up-to-date diagnostic testing.

How we treat achalasia

Your care team will evaluate your symptoms and choose the most appropriate treatment. Treatments for achalasia can include:

POEM endoscopic treatment. At NewYork-Presbyterian, we offer an innovative treatment for achalasia called peroral endoscopic myotomy (POEM), which is only available at medical centers with the expertise and resources to offer such advanced therapies. While you are fully sedated under general anesthesia, your doctor advances an endoscope to the lower esophageal sphincter and cuts the dysfunctional muscles that are preventing your sphincter from opening, allowing food to enter your stomach more easily. Some patients may be able to go home the same day.

Minimally invasive achalasia surgery. A Heller myotomy can make it easier to swallow. A surgeon performs this minimally invasive procedure through tiny incisions in your abdomen to release the muscles around the lower esophageal sphincter, allowing food to pass more easily into your stomach. To prevent reflux after the procedure, the surgeon typically performs a partial “wrap” of the stomach around your esophagus. In some cases, this procedure may be performed using robotic surgery.

Pneumatic balloon dilation. The lower sphincter can be dilated using a specially designed large balloon placed into the esophagus.

Botulin toxin (Botox) injection of the lower esophageal sphincter can help improve sphincter emptying. The results may be temporary.

Why Choose Us

Not all medical centers have clinicians with experience diagnosing and treating achalasia. There are a variety of treatments available, with some more effective than others. At NewYork-Presbyterian, we are experienced in offered all achalasia therapies, including the latest approaches, and will match you with those that are likely to help you most. Call us today to make an appointment so you can start feeling better sooner.