Achalasia

Achalasia is an important esophageal motor disorder that causes dysphagia, disrupting patients’ nutrition and decreasing their quality of life. The pathophysiological basis of this disorder is the loss of peristalsis in the esophagus and insufficient relaxation of the lower esophageal sphincter (LES). Major clinical signs; Dysphagia against both solids and liquids, regurgitation of the esophageal contents, heartburn, retrosternal chest pain, cough, aspiration, and weight loss. Achalasia was first described and named by Sir Thomas Willis in 1674. (1)

Esophageal manometry is the gold standard for diagnosis. It usually starts insidiously. Swallowing disorder, chest pain may even manifest with symptoms. Diagnosis can usually take 2-3 years. (2)

Treatments

Pharmacotherapy: calcium channel blockers and long acting nitrates;

Botulinum toxin injections into LOS

Pneumatic expansion of LOS

peroral endoscopic myotomy (POEM);

laparoscopic Heller cardiomyotomy (LHC) (3)

Surgical Treatment

It is known as Heller myotomy (Esopageal myotomy), a procedure in which the muscles around the esophagus are opened and cut. (4)

Studies have reported that Laparoscopic Heller Myotomy surgery is effective in 85% of children. (5)

For example, our patient, E.K, was 23 years old and had only been fed with liquid for the last 3 years. Before the operation, endoscopy, chest X-ray and tomography examinations were performed. Heller myotomy was applied laparoscopic.

Per-oral endoscopic myotomy can be applied in patients whose Heller myotomy operation is ineffective. (6)

1. ATEŞ, F. (2019). Akalazya Patofizyolojisi. Türkiye Klinikleri Genel Cerrahi-Özel Konular, 12(2), 8-15.
2. Pohl, D., & Tutuian, R. (2007). Achalasia: an overview of diagnosis and treatment. Journal of Gastrointestinal and liver diseases, 16(3), 297.
3. Midya, S., Ghosh, D., & Mahmalat, M. W. (2019). Fundoplication in laparoscopic Heller’s cardiomyotomy for achalasia. The Cochrane Database of Systematic Reviews, 2019(7).
4. Khairunnisa, N. (2020). Esophageal Myotomy pada Achalasia. MEDULA, 10(2), 234-240.
5. Pacilli, M., & Davenport, M. (2017). Results of laparoscopic Heller’s myotomy for achalasia in children: a systematic review of the literature. Journal of Laparoendoscopic & Advanced Surgical Techniques, 27(1), 82-90.
6. Zhang, X., Modayil, R. J., Friedel, D., Gurram, K. C., Brathwaite, C. E., Taylor, S. I., … & Stavropoulos, S. N. (2018). Per-oral endoscopic myotomy in patients with or without prior Heller’s myotomy: comparing long-term outcomes in a large US single-center cohort (with videos). Gastrointestinal endoscopy, 87(4), 972-985.