It is a rare condition of unknown cause that affects 1:100.000 of the population annually. It affects patients of all ages, however it usually develops at 30-60 of age. It occurs with the same frequency in both sexes.
It is a functional disorder of the esophagus characterized by failure of the lower esophageal sphincter to relax and disorganized (non peristaltic contractions) of the esophagus.
Symptoms:
This results in the occurrence of the following symptoms
A) Dysphagia with both solids and liquids (80%)
B) Regurgitation (75%)
C) Retrosternal pain (20%)
D) Weight loss due to poor nutrition
Diagnosis
Achalasia is diagnosed via the medical history, the clinical picture and by performing specific tests such as esophageal manometry and esophagography.
Treatment:
- Medical treatment – usually with no results.
- Esophageal dilatation by endoscope. However, symptoms may recur and there is always the risk of severe complications (esophageal perforation – 5%)
- Surgical treatment
The surgical treatment of choice is Heller myotomy, where a longitudinal incision on the lower 6-8 cm of the esophagus is performed with satisfactory results in over 90% of patients. This procedure may be followed by fundoplication (Nissen, Dor or Toupet) to prevent reflux esophagitis. Currently, this procedure is performed laparoscopically using minimal incisions with spectacular results.