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.
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
Achalasia is diagnosed via the medical history, the clinical picture and by performing specific tests such as esophageal manometry and esophagography.
- 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.