University College Hospital. Achalasia. Gastrointestinal Services Division Physiology Unit

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Maximillian Owens
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University College Hospital Achalasia Gastrointestinal Services Division Physiology Unit Author: Dr Anton Emmanuel, Consultant Gastroenterologist First published: September 2012 Last review date:

1 University College Hospital Achalasia Gastrointestinal Services Division Physiology Unit Author: Dr Anton Emmanuel, Consultant Gastroenterologist First published: September 2012 Last review date: February 2015 Next review date: February 2017 Leaflet code: UCLH/S&C/GI/PHYSLGY/ACHALASIA/1 University College London Hospitals NHS Foundation Trust Created by Medical Illustration RNTNEH Unique Code: 28974

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3 10 3 Space for notes and questions If you need a large print, audio or translated copy of the document, please contact us on We will try our best to meet your needs. Contents The oesophagus (gullet) 5 What is achalasia? 5 Who suffers from achalasia? 5 What are the symptoms of achalasia? 5 What tests may be performed? 6 How is achalasia treated? 7 Where can I get more information? 8 Contact Details 8 How to find us 9 Space for notes and questions 10

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5 8 5 Where can I get more information? Achalasia is a well defined medical condition of the oesophagus and further information about it is readily found online or in gastroenterology text books. For example, on Patient.co.uk Website: Note: This website is provided for information and education purposes only. No guarantees or warranties are made regarding any of the information contained within this website. Contact Details This information leaflet tells you about achalasia but if you have read the leaflet and have any queries please contact the GI Physiology Unit. Address: GI Physiology Unit University College Hospital Lower Ground Floor, EGA Wing 235 Euston Road London, NW1 2BU Telephone: (Monday to Firday 09:00 to 17:00) Switchboard: or (All other times) Fax: gi.physiology@uclh.nhs.uk The oesophagus (gullet) The oesophagus or gullet is a muscular tube which joins the mouth to the stomach. When you swallow, the gullet squeezes and relaxes in a coordinated manner to push food into the stomach. This is known as peristalsis. There is a specialised area at the bottom of the gullet called the lower oesophageal sphincter (LOS). When you swallow, the LOS opens to allow the passage of food and drink into the stomach. What is achalasia? You may have been diagnosed with a condition called achalasia. This is a disease that affects the nerves of the gullet and LOS. In patients with achalasia there is an absence of the process of peristalsis to help push food down the gullet and the LOS typically fails to open to let food pass into the stomach. It does not affect other parts of the body and therefore once the symptoms are treated it will not affect your general health. Who suffers from achalasia? Achalasia is a rare condition that affects approximately 6000 people in Britain. It is usually diagnosed in adults but may occur in children as well. There is no particular race or sex that is affected and it does not run in families. What are the symptoms of achalasia? People with achalasia have difficulty swallowing food. At first only large pieces of food such as meat and bread may be difficult to swallow but even drinking water may become problematic as the symptoms continue. As your swallowing deteriorates you may cough or choke and even regurgitate or vomit the food or drink. As your symptoms become worse you may lose weight. It often helps to sit bolt upright and to take your time when eating, walking around may help food to pass down the gullet.

6 6 7 You may find that you get some regurgitation of food and saliva at night and that you are unable to sleep lying flat. If food does not pass into the stomach and is not regurgitated, it may sit in the gullet for some time causing the sensation of heartburn or pain around the stomach and gullet. Some people may experience episodes of food sticking in the gullet for some time and on occasion the piece of food may need to be removed with an endoscopy procedure in hospital. What tests may be performed? Barium swallow This is a test when you are given a drink of a thick X-ray liquid, and then a series of X-rays are taken. This provides an outline of the gullet and stomach on the X-ray screen and can sometimes be useful in diagnosing achalasia. Endoscopy This procedure involves passing a long thin telescope through the mouth, into the oesophagus and stomach. This gives a clear view of the lining of the oesophagus and stomach. Problems with peristalsis may be suspected if there is food retained in the oesophagus or if there is a narrowing at the LOS. Stationary oesophageal manometry This is the definitive test for achalasia. A thin plastic tube is passed via the nose, down the gullet, into the stomach. Passing the tube may make you retch or gag a little but it is not painful and sedation is not required. You will then be asked to take a few swallows of water while recordings are made. The tube measures the pressure along your gullet and in the LOS and is the best test to see if you have achalasia. How is achalasia treated? Achalasia can be treated in a variety of ways according to your individual situation. All are directed at decreasing the pressure of the LOS so that food is able to pass into the stomach. Pneumatic dilatation The LOS is dilated or stretched using a balloon. This is carried out during endoscopy and has a 75 per cent chance of relieving your symptoms for many years. This stretches the muscles in the LOS so that it no longer obstructs food from entering the stomach. The main complication is that there is an approximately three per cent risk of perforating the gullet. Surgery The muscles in the LOS are cut in an operation called a Heller s myotomy. This may be performed though open incisions in the abdomen and left side of the chest; in some hospitals the procedure can be performed via keyhole surgery (laparoscopy). Surgery to prevent acid reflux (fundoplication) may be undertaken at the same time. Botulinum toxin (Botox ) This is a more recent treatment in which Botox is injected into the LOS during endoscopy. The toxin paralyses the muscles in the LOS permitting food to pass into the stomach. However, the effects may not be long lasting and there is a very small chance of perforation (less than one per cent). Medication Drugs known as calcium channel blockers or nitrates may relax the LOS. However, this treatment is considered less effective than either dilatation or surgery and is therefore mainly used for short periods of time such as whilst waiting for tests or other treatment options.

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UG21 Laparoscopic Heller's Cardiomyotomy Further information You can get more information and share your experience at www.aboutmyhealth.org Local information You can get information locally from:.........