Achalasia and primary esophageal motility disorders

What is it?

It is a disease characterized by the absence of peristalsis of the esophageal body, that is, a failure to propagate the waves that allow food to travel down the esophagus and into the stomach. The actual cause of this disease is not known.

Causes and risk factors

It affects men and women of almost all ages equally, especially between the ages of 30 and 60 with a peak around 40. The incidence is about 8 cases per 100,000 inhabitants per year.

Which are the symptoms?

  • Dysphagia (sensation of obstructed transit of food through esophagus) that first arises in episodes, then constantly. Didactically it is called 'paradoxical' because it is often more pronounced for liquids than for solids.
  • Retrosternal pain.
  • Regurgitation (return to the mouth, without gagging, of undigested material, characteristically non-acidic because it has never reached the stomach).
  • Significant weight loss, closely related to the course and duration of the disease.

How is it diagnosed?

Diagnosis is possible by esophagogastroduodenoscopy, the radiologic study of esophageal transit, and esophageal manometry.

Suggested exams

How is it treated?

  • Pharmacological therapy: drugs that reduce the tone of the lower esophageal sphincter are administered, in particular calcium antagonists possibly associated with nitrates.
  • Mechanical dilatation: pneumatic balloons are inflated under endoscopic control at the level of the cardial junction (which separates the esophagus from the stomach) until they tear the muscle fibers of the lower esophageal sphincter and allow the subsequent passage of food into the stomach.
  • Botulinum treatment: the injection of botulinum toxin at the level of the lower esophageal sphincter carried out endoscopically; it is an effective treatment, easy to perform and without risks for the patient. The treatment must, however, be repeated several times and its long-term effectiveness is not yet known.
  • Surgical therapy: extramucosal myotomy according to Heller combined with an antireflux plastic guarantees the best result. This technique can be performed according to the traditional approach or by laparo/thoracoscopic approach.

Where do we treat it?

Within the San Donato Group, you can find Achalasia and primary esophageal motility disorders specialists at these departments:

Are you interested in receiving the treatment?

Contact us and we will take care of you.