Achalasia is a rare disease of the muscle of the esophagus (swallowing tube). The term achalasia means "failure to relax" and refers to the inability of the lower esophageal sphincter (a ring of muscle situated between the lower esophagus and the stomach) to open and let food pass into the stomach. As a result, people with achalasia have difficulty swallowing food. In addition to the failure to relax, achalasia is associated with abnormalities of esophageal peristalsis (usually complete absence of peristalsis), the coordinated muscular activity of the body of the esophagus (which comprises 90% of the esophagus) that transports food from the throat to the stomach.
The disease can manifest at any age and usually leads to dysphagia.
Patients can have reflux symptoms associated and gradually the esophagus dilates.
The lower end of the food pipe become thin and shows a bird beak appearance on barium study.
The surgery for Achalasia is Laparoscopic Cardiomyotomy or Hellers myotomy.
The muscle fibres in the sphincter are divided (cut) during an operation. This is often done by keyhole surgery. This is usually very successful at easing the symptom of difficulty swallowing.
Recently I saw Raniben, 55 yearold housemaker who was diagnosed with Achalasia 12 years ago and feared to get surgery done. I convinced her to understand the disease and later she got the Lap Cardiomyotmy done.
She is feeling absolutely fine and totally asymptomatic.
Her words describe the surgery
“I began developing symptoms of achalasia over about 14 years ago. I was diagnosed with Achalasia after 2 years of initial symtoms. My symtoms became so bad that I could barely consume clear liquids standing up. I lost 20 kg and would wake almost every night choking on food, liquid or just saliva. It took me a 12 years to decide to get the Heller myotomy with Dor fundoplication. It was Dr Nagpal’s confidence that assured me. Since the operation, a little over two months ago, I can eat almost normally and can sleep lying down without problem. I still need to watch what I eat, eat slow”