Achalasia

Achalasia is an uncommon esophageal motility disorder in which the lower esophageal sphincter – the ring of muscle where the esophagus meets the stomach – doesn’t relax as it should during swallowing.

Typically caused by damage to the esophageal nerves, achalasia also can limit muscle function (peristalsis) in the esophagus.

The specialized thoracic surgeons at UT Southwestern Medical Center perform advanced procedures to treat achalasia – some of which can be performed minimally invasively, including robotically. We offer the latest treatments for this disease, including POEM (peroral endoscopic myotomy) and advanced imaging techniques. Our collaborative approach involves experts from gastroenterology to deliver comprehensive care – all in one location and usually in the same day.

Diagnosis

If we suspect that you have achalasia, we will conduct a physical examination and order tests to confirm the diagnosis.

Tests and imaging techniques used to diagnose achalasia might include:

• Endoscopy to look directly at inner walls of the esophagus to evaluate narrowing
• Esophageal manometry to confirm no peristalsis via pressure tests
• Upper GI and small bowel imaging to evaluate peristalsis
• X-ray with barium contrast to visualize narrowing of the lower esophagus

Treatments

We treat achalasia with procedures that include:

• Balloon dilation of the lower esophagus
  
• POEM (peroral endoscopic myotomy): Surgical manipulation of the valve at the junction of the stomach and the esophagus (the lower esophageal sphincter) to reduce pressure
  
• Heller myotomy: A last-resort surgery in which the lower esophageal sphincter muscle is cut to allow food to pass through
  

Related Conditions

Our Thoracic Surgery team treats the full range of thoracic (chest) conditions that can be associated with achalasia. These include:

• Barrett’s esophagus
• Benign esophageal tumors
• Esophageal cancer
• Esophageal perforation
• Esophageal nodules and masses, including leiomyoma and gastrointestinal stromal tumors (GISTs)
• Esophageal reflux, also known as gastroesophageal reflux disease (GERD)
• Esophageal strictures
• Hiatal hernia, including giant hiatal hernia with gastric volvulus and paraesophageal hiatal hernia
• Other esophageal motility disorders
• Tracheoesophageal fistulas

Clinical Trials

In addition to standard treatments for achalasia, UT Southwestern gives patients access to the most promising new therapies through clinical trials. Talk to your doctor about clinical trials that may be right for you.