I have difficulty swallowing and have been diagnosed with achalasia. Are there any new treatments?

In response to a question on healthshare.com.au

Achalasia is one of the ineffective oesophageal motility disorders. Usually, the oesophagus (the food pipe) transmits food downwards by a sequence of controlled and well-timed contractions (called ‘peristalsis’). This is why most people can drink water through a straw while standing on their head (if they wanted to!). People with achalasia cannot, because the contractions of their oesophagus are absent. People with achalasia rely on gravity to help them swallow, and indeed they can have serious problems swallowing. Certain foods, such as dry white breads, gluggy rice, and chunky pieces of steak are the hardest to swallow. Not only can people with achalasia feel that the food “doesn’t go down”, they can also get chest pain and heartburn.

There are tablets that have been tried to help relieve the symptoms of achalasia, but unfortunately none of these work very well. Other treatments aim to allow the oesophagus to empty better under gravity, by decreasing the resistance of the bottom of the oesophagus. These other treatments include Botox injection, balloon dilation, keyhole surgery, and the very new no-incision, no-scar POEM therapy.

Botox is a medication many people know from its use in cosmetic surgery where it is injected into the face to paralyze the muscles associated with wrinkles. It can also be injected into the lower oesophagus to paralyze the muscles there and promote emptying of the oesophagus. Though it usually works very well, its duration of action is usually less than 6 months. Balloon dilation aims to achieve a partially-controlled rupture of part of the oesophagus’ muscle wall. It has to a large degree been replaced by a keyhole surgery operation called “Heller’s myotomy”. This operation allows the surgeon to cut the lower part of the oesophagus in a very controlled manner to help with swallowing.

The newest procedure is the POEM procedure. The aim of the operation is to replicate the keyhole Heller’s operation, but in this case without cutting the skin and with no scars. The entire procedure is performed though the mouth. Few surgeons in Australia perform this procedure. Please ask your doctor if any of these procedures might be suitable for you, or please contact me for more information.