Dr. Matthew Smith explains what achalasia is and how it can be treated.


What is achalasia?

Achalasia is a strengthening of the lower esophageal sphincter (hypertrophy) that's between the esophagus and the stomach. It tends to become overly prominent, and it doesn't relax. When that happens, patients complain about a lot of dysphagia or food sticking. They feel like food goes down, but it really gets stuck right in this area. Sometimes they can have pain, and they can actually regurgitate the food back up. They say, "I can't eat solid food anymore. I can only drink liquids." What you see endoscopically is it's very difficult to get that scope down the throat into the esophagus and into the stomach sometimes. You feel it pop as you get into the stomach. With some other testing, you can figure out if the patient truly has achalasia.

How do you treat achalasia?

We cut that muscle either endoscopically, meaning down the scope with the throat using the POEM procedure (peroral endoscopic myotomy), or you can do it laparoscopically with tiny incisions on the abdomen and we cut that muscle. We also do a partial fundoplication to help with reflux where we flip the stomach over on top of itself to help with acid reflux disease. There are some really good treatments. After the procedure, most patients feel fantastic. They can eat again. They can drink again. They've kind of got a lot of their quality of life back, which is really neat.