Achalasia / Motility Disorders

When the tube that connects your throat to your stomach doesn’t function properly, you may have a motility disorder. The most common motility problem is achalasia. This occurs when your esophageal peristalsis (the muscle contractions that push food down to the stomach) isn’t working and your lower esophageal sphincter (the valve that allows food to enter the stomach) does not relax to let food move. If you have achalasia, you may experience difficulty swallowing, chest pain, unintended weight loss, and regurgitation. You may even have dry eyes and mouth.

We do not know what causes achalasia, though we suspect there is a genetic component. It usually affects adults between ages 25 and 60. Men and women have similar chances of getting achalasia.

We use several approaches to diagnose achalasia:

• X-rays: After you drink a smooth chalky liquid or take a barium pill, we can take pictures of the inside lining of your digestive tract to show any blockages.
• Esophageal manometry: This test measures the muscle contractions in your esophagus so we can see what happens when you swallow.
• Endoscopy: We may use a thin, flexible tube with a camera at one end to view the inside of your esophagus and stomach. We can also use an endoscopy to take a tissue sample for testing.

Treatments We Offer

Traditional treatments for achalasia include medications, such as Botox, and endoscopic techniques, such as dilation. But these approaches are not long-lasting; your symptoms may come back. Surgery provides long-term relief from this problem.

We surgically divide your lower esophageal sphincter muscle to allow food to pass easily into the stomach. At Mount Sinai, we use minimally invasive techniques to accomplish this.

The most common minimally invasive technique we employ is called laparoscopic Heller myotomy (LHM). We make several small incisions in the abdomen. Guided by a camera, we divide the sphincter muscle. Another option is the video-assisted thoracoscopic surgery (VATS) Heller myotomy (VHM). To perform this procedure, we make a few small incisions along the side of the left chest. Then we use a camera and instruments to divide the sphincter muscle. You should be able to go home the next day. The small incisions are barely visible several weeks after the procedure.

Achalasia and Esophageal Diverticulum

If you have achalasia, you may also develop an esophageal diverticulum. This is when your esophagus sticks out in a way that is not normal. You may have additional symptoms, such as regurgitating your food a few hours after eating or bad breath (halitosis). We use minimally invasive techniques to divide your sphincter muscle and diverticulum.

If the achalasia is left untreated for too long, you may not be able to get food down into your stomach. The esophagus may become too dilated and twisted. We use a Heller myotomy to treat the condition. If this is not effective, we may need to remove your entire esophagus (esophagectomy). At Mount Sinai, our thoracic surgeons have expertise in minimally invasive esophagectomy. With this procedure, we remove the esophagus through the abdomen and chest without breaking open your ribs.