Achalasia & Heller Myotomy

What is achalasia?

Achalasia is a condition that affects the oesophagus. If you are suffering from achalasia, your lower oesophageal sphincter (LES) fails to open during swallowing. This can lead to a backup of food within your oesophagus.

There are several different causes of achalasia, and it can often be difficult for your doctor to identify a specific cause. Some causes of achalasia are:

  • Autoimmune condition – this causes your body to mistakenly attack healthy cells in the body, which can lead to the degeneration of nerves in the oesophagus, contributing to achalasia.
  • Hereditary – achalasia is a condition that can be hereditary in families.

Other conditions can cause symptoms that are similar to achalasia, such as oesophageal cancer, so it is important if you are experiencing any of the following symptoms you should seek medical attention.

Achalasia Symptoms

If you find that you are having trouble swallowing both solids and liquids (and this worsens over time), you may have achalasia and should look for other signs or symptoms. Symptoms of achalasia can include:

  • Reflux sensation (heartburn)
  • Intense pain or discomfort after eating
  • Weight loss
  • Pain or discomfort in the chest (similar to heartburn)
  • Regurgitation

If you are experiencing any of these symptoms you should seek medical attention from your doctor.

Achalasia Diagnosis

If your doctor suspects you may have achalasia following a physical exam and a series of tests, you will likely be referred to a specialist who will perform the some or all of the following diagnostic tests:

  • Oesophageal manometry
  • X-ray
  • Endoscopy
  • Barium Swallow

Achalasia Treatment & Surgery

As achalasia is caused by the LES not opening correctly for food to pass to the stomach, achalasia treatment is focused on relaxing or stretching the LES. There are non-surgical and surgical treatments for achalasia. The achalasia treatment that your doctor will recommend will be dependent on your age, health and medical history.

Non-Surgical Achalasia Treatment

There are several different non-surgical achalasia treatments available, however they are generally only offered in the circumstance that a patient isn’t a suitable candidate for surgery. They include:

  • Medication – muscle relaxants are an option, but have limited treatment effect and potentially severe side effects.
  • Botox – botox is a muscle relaxant that is injected directly into the LES. Botox isn’t a permanent, long-term solution so multiple injections may need to be repeated, meaning this treatment is often only used for patients who aren’t candidates for surgery.
  • Pneumatic Dilation – this is an outpatient procedure that uses a balloon. The balloon is inserted into the centre of the LES and then inflated to enlarge the opening. This treatment may need to be repeated and again usually means this treatment is often only used for patients who aren’t candidates for surgery.

Achalasia Surgery

Surgery is the most effective treatment for achalasia, for suitable patients. The standard surgery for achalasia is Heller Mytomy. Find out more about achalasia surgery below.


Heller Myotomy

During a Heller Myotomy, A/Prof Pilgrim will cut the muscle at the LES, which will allow food and liquid to pass more easily into the stomach. The Heller Myotomy procedure can be performed with minimally invasive surgery (robotically or laparoscopically), requiring smaller incisions, resulting in fewer potential complications and faster recovery times for the patient.

Patients who undergo a Heller Myotomy procedure may later develop gastroesophageal reflux disease (GORD) and therefore Fundoplication is usually combined with the Heller Myotomy procedure to help prevent GORD.

If you are suffering with achalasia and wish to discuss treatment and surgery options, you can call our practice on (03) 9509 4811 to make an appointment, or you can book an appointment online