Achalasia Treatment
Achalasia
Patient Information
Achalasia is a rare disorder of the oesophagus (food pipe) that affects swallowing. It occurs when the muscles of the oesophagus do not work properly and the valve between the oesophagus and stomach (the lower oesophageal sphincter) fails to relax during swallowing.
As a result, food and liquid do not pass easily into the stomach and can build up in the oesophagus.
What Causes Achalasia?
Achalasia is caused by damage to the nerves that control movement of the oesophagus and relaxation of the lower oesophageal sphincter. The exact reason this nerve damage occurs is not fully understood.
What is known:
It is not caused by diet or lifestyle
It is not contagious
It is not caused by acid reflux
It is not a cancer, although symptoms can overlap with other conditions
Achalasia is a long-term condition, but effective treatments are available to improve swallowing and quality of life.
Symptoms of Achalasia
Symptoms vary between individuals and may include:
Difficulty swallowing solids and liquids
Food or fluid coming back up (regurgitation)
Chest discomfort or pain
Sensation of food sticking in the chest
Weight loss due to reduced intake
Night-time coughing or choking
Recurrent chest infections (in some patients)
Because symptoms can be slow to develop, diagnosis is sometimes delayed.
How Achalasia Is Diagnosed
Diagnosis requires specialist assessment and investigations.
Common tests include:
Oesophageal manometry
Measures muscle contractions and sphincter relaxation (gold standard test)
Gastroscopy (OGD)
Excludes other causes of swallowing difficulty and assesses oesophageal emptying
Barium swallow X-ray
Shows delayed emptying and characteristic oesophageal changes
These tests confirm the diagnosis and help guide treatment.
Treatment Options for Achalasia
Achalasia cannot currently be cured, but treatment aims to reduce resistance at the lower oesophageal sphincter, allowing food to pass into the stomach more easily.
Available treatments include:
Endoscopic balloon dilatation
Botulinum toxin injection (temporary effect)
Surgical myotomy (Heller myotomy)
Per-oral endoscopic myotomy (POEM)
The most appropriate option depends on age, symptoms, achalasia subtype, and patient preference.
Laparoscopic Heller Myotomy
What is a Heller myotomy?
A laparoscopic Heller myotomy is a keyhole surgical procedure that divides the tight muscle at the lower end of the oesophagus. This reduces outflow resistance and improves swallowing.
The procedure is usually combined with a partial anti-reflux wrap to reduce the risk of acid reflux after surgery.
Why Surgery Is Considered
Surgical myotomy is a well-established and durable treatment for achalasia and is often recommended for patients who:
Have persistent symptoms
Are suitable for surgery
Prefer a long-term solution
Have failed or relapsed after non-surgical treatments
What the Operation Involves
Performed under general anaesthetic
Keyhole (laparoscopic) approach
The tight oesophageal muscle is carefully divided
A partial fundoplication may be added to reduce reflux
Typically requires 1 night in hospital
Recovery After Surgery
Most patients recover steadily following laparoscopic Heller myotomy.
After surgery
Gradual reintroduction of diet
Temporary swallowing discomfort may occur
Walking encouraged early
Pain is usually mild to moderate
Typically requires 1 night in hospital
Activity guidance
No driving for 2 weeks
No lifting more than 2 kg (a full kettle) for 4 weeks
Gradual return to normal activity
Expected Outcomes
In appropriately selected patients, Heller myotomy is associated with:
Significant improvement in swallowing
Reduction in regurgitation
Improved quality of life
Long-term follow-up is important, as some patients may develop reflux or recurrent symptoms over time.
Important Reassurance
Achalasia is not cancer
Symptoms are treatable
Surgery aims to improve function, not remove the oesophagus
Treatment choice is individual and evidence-based
Careful assessment is essential before intervention
Long-term follow-up is important, as some patients may develop reflux or recurrent symptoms over time.
Achalasia – Frequently Asked Questions
Common queries related to the Achalasia.
Is achalasia the same as acid reflux?
Will achalasia go away on its own?
Is surgery the only treatment?
Is laparoscopic Heller myotomy safe?
Will I need medication after surgery?
Can symptoms come back after treatment?
When should I seek specialist assessment?
Key Message for Patients
Achalasia is a rare but well-recognised condition.
Accurate diagnosis, careful selection of treatment, and experienced surgical care are central to achieving good long-term outcomes.
About Us
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Our Branches
Spire South Bank Hospital:
139 Bath Rd, Worcester, WR5 3YB, UK
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