Achalasia is an esophageal motility disorder that is characterized by the severe retention of food and liquids in the esophagus. In achalasia, the esophagus loses its ability to contract normally and the lower esophageal sphincter fails to relax completely, thereby preventing the normal flow of food into the stomach. Patients with achalasia experience the sensation of food sticking in their throat or chest and may experience severe regurgitation, nighttime coughing and weight loss.
Achalasia results from the loss of nerve cells within the muscular layers of the esophagus. The cause of this nerve cell loss in unknown. Achalasia is treated by decreasing the lower esophageal sphincter pressure with oral medications, balloon dilation, injection of botulinum toxin (Botox) or surgery (laparoscopic Heller’s myotomy). An exciting new technique called the POEM procedure has recently been developed to treat patients with achalasia. POEM stands for per-oral endoscopic myotomy. This technique allows for a myotomy to be performed using an endoscope inserted through the patient’s mouth rather than by instruments passed through incisions in the abdominal cavity. The patient therefore has no external scars following this procedure. The decision about which procedure is most appropriate for a given patient is made after careful discussion of the risks and benefits of the various treatment options and consideration of factors such as the patient’s age, underlying medical condition and personal preference.