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Normal anatomy:

The esophagus carries food from the mouth to the stomach. The lower esophageal sphincter is a muscular ring at the junction of the esophagus and the stomach. The lower esophageal sphincter relaxes when food from the esophagus enters the stomach.


Normal anatomy


Indications:

Achalasia is a disorder in which the lower esophageal sphincter does not relax when food passes down the esophagus to the stomach. As a result, the esophagus becomes distended and filled with food, and food passes into the stomach very slowly. Achalasia is often associated with chest pain during eating, weight loss, and regurgitation of food. The lower esophagus becomes distended as food and liquid are unable to pass into the stomach.


Indications


Procedure, part 1:

Achalasia can sometimes be treated with medication that helps the lower esophageal sphincter relax. If medication is ineffective, however, esophageal dilatation can correct the problem. To open the esophagus, a balloon dilator is passed through the mouth down to the level of the lower esophageal sphincter, using an endoscope. The balloon is inflated, thus stretching the sphincter.


Procedure, part 1


Incision:

If achalasia recurs after balloon dilatation, surgery may be necessary to correct the defect. This surgery can often be done laparoscopically. Laparoscopic surgery involves a number of small incisions made in the upper abdomen, into which the surgeon inserts a long, thin camera and surgical instruments.


Incision


Procedure, part 2:

The surgeon then makes a long incision in the esophagus at the level of the esophageal sphincter. This releases the sphincter and allows it to relax. This surgery is very effective in curing achalasia, with over 90% of patients obtaining relief from symptoms post-operatively. Recovery is generally rapid, and most patients are able to leave the hospital within 1 to 3 days. Infrequently, the operation cannot be accomplished laparoscopically, and a larger incision is required. In these cases, hopitalization times may be longer.


Procedure, part 2



Review Date: 2/20/2008
Reviewed By: Christian Stone, MD, Division of Gastroenterology, Washington University in St. Louis, School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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Wentworth-Douglass Hospital
789 Central Avenue, Dover, NH 03820
Phone: (603) 742-5252
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