Achalasia

What is achalasia?

Achalasia (which means “failure to relax”) is a motility disorder of the esophagus, the tube through which food travels to the stomach. In children with achalasia, the muscles in the esophagus stop effectively moving food through the esophagus. The lower esophageal sphincter (LES) — the muscular ring at the point where the esophagus and stomach meet — also fails to relax completely during swallowing. This makes it difficult for food to pass into the stomach.

Causes of achalasia

The exact cause of achalasia is unknown. Studies have proposed an association with autoimmune, viral and neurodegenerative triggers that may lead to the loss of inhibitory neurons in the nerves in the esophagus that coordinate esophageal contractions and relaxation of the LES during a meal.

Signs and symptoms

A major symptom of achalasia is difficulty swallowing. Children with achalasia may feel like food is getting stuck in their throats. Regurgitation of food after meals, chest pain and weight lost can also be seen in patients with achalasia.

Testing and diagnosis of achalasia

Children with symptoms commonly seen in achalasia may require an endoscopy (EGD). Other diagnostic tests may include a timed barium esophagogram (TBE) and an esophageal manometry/high resolution manometry (HRM). Currently, EndoFLIP technology is being tested as a potential diagnostic test for achalasia.

An upper endoscopy allows your child's doctor to use an endoscope (a long, thin tube) to look at the lining of your child's esophagus, stomach and proximal small bowel. This is done to confirm the absence of mechanical obstruction, and exclude infectious and inflammatory causes of presenting symptoms. In achalasia, an upper endoscopy may reveal retention of liquids and solids in the esophagus or a dilated esophagus.

Timed barium esophagogram (TBE)

In a barium study, your child drinks a barium liquid that coats the upper GI tract, illuminating the flow of the liquid through the esophagus, stomach and duodenum. Completed under the careful supervision of a radiologist, this test may reveal a dilated esophagus, dysmotility (when the muscles of the esophagus, stomach or intestines aren't coordinating as they should) or narrowed gastroesophageal junction (GEJ).

Manometry

Esophageal manometry measures the rhythm and coordination of muscle contractions in your child’s esophagus during swallowing. During esophageal manometry, a thin, flexible tube is inserted through the nose, down the esophagus and into the stomach. Esophageal manometry is the gold standard diagnostic test in achalasia and reveals lack of esophageal motility and impaired relaxation of the LES.

EndoFLIP technology

EndoFLIP is a novel device composed of a catheter (thin tube) that is inserted in the esophagus during an endoscopy with a small balloon in the tip that is inflated when placed across the LES and measures its diameter and stiffness. The EndoFLIP allows the physician to visualize any narrowing at the moment of the study and decide if the area requires dilation.

Treatment for achalasia

Pneumatic dilation

Under anesthesia, balloons of different sizes are slowly inflated when positioned across the LES, leading to disruption of the LES circular muscle fibers and releasing the pressure of a non-relaxing LES.

Myotomy

Under anesthesia, the muscles around the LES are surgically disrupted, opening the tight LES and relieving symptoms. 

Esoflip®

The Esoflip® catheter is a thin tube that is inserted in the esophagus during endoscopy and placed across the LES. The doctor slowly inflates a balloon that dilates the narrowed LES providing relief of the tight segment. The doctor is able to visualize the dilation live. One of the great benefits of Esoflip-guided dilation is that it eliminates exposure to radiation during dilation.

Long-term outlook

Currently, there is no cure for achalasia. Doctors focus on reducing symptoms by improving the movement of liquids and solid from the esophagus to the stomach.

Follow-up care

Patients with achalasia may require repeat visits depending on resolution of symptoms.

Why choose us

We have a dedicated group of physician that have trained in the latest diagnostic and treatment procedures used in patients with achalasia.