# Achalasia --- **Achalasia** is a condition of the [[esophagus]] where there is absent or ineffective [[peristalsis]] in the esophagus, as well as a failure of the esophageal sphincter to relax appropriately, which together result in food being trapped in the bottom of the esophagus. This results in a dilation of the esophagus in the chest over time, as well as the complications of having food start to rot inside your body. ## Signs & Symptoms The biggest, most unsettling sign of achalasia is the feeling of ood being stuck in the lower esophagus. There is also: - [[pyrosis]] - secondary pulmonary aspiration from gastic content ## Diagnostic Tests - [[x-ray]]/[[x-ray|CT scan]] - [[barium swallow]] - [[endoscopy|EGD]] - [[esophageal manometry]] ## Treatment The treatement for achalasia is lifestyle changes and if that doesn't work there are some surgical interventions that can be performed. The key thing is to eating and drinking slowly, which gives the food time to get into the stomach I guess. There are two surgical interventions that can be done for achalasia, pneumatic dilation and endoscopic myotomy. - **Pneumatic dilation** is a pretty effective procedure that can be done under moderate sedation. A baloon is inserted down the esophagus and then inflatted to help open up the sphincter. It's pretty safe, but there is a low risk of perforation. {I don't know how this doesn't immediately cause GERD} ![[pneumatic dilation.png]] - **Peroral endoscopic myotomy**, or **POEM** treats achalasia by creating a larger opening for the food and fluids to go through by essentially digging through the muscle layer of the esophagus. ![[peroral endoscopic myotomy.png]] ___