Dysphagia refers to difficulty swallowing, which can occur due to various underlying conditions. Achalasia is a specific disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and lack of peristalsis in the esophagus, leading to difficulty swallowing and the sensation of food sticking in the chest.

Dysphagia and achalasia can be managed through a variety of treatments aimed at relieving symptoms and improving swallowing function. These treatments may include dietary modifications, medications to relax the LES, and minimally invasive procedures such as endoscopic balloon dilation, peroral endoscopic myotomy (POEM), or laparoscopic Heller myotomy. Medications are generally not very effective, and come with bothersome side effects, so a procedure or surgery is usually the best choice for patients who want to be able to swallow normally.

Endoscopic balloon dilation is a minimally invasive procedure used to treat achalasia by stretching and widening the lower esophageal sphincter (LES) using an inflatable balloon passed through the mouth while you are asleep, into the esophagus. This helps to improve swallowing function by allowing food and liquids to pass more easily into the stomach.

Peroral endoscopic myotomy (POEM) is a relatively newer technique for treating achalasia, where a flexible endoscope is used to create a tunnel through the inner lining of the esophagus and then into the muscle layer. The muscle fibers of the lower esophageal sphincter (LES) are then cut to allow for easier passage of food into the stomach.

Laparoscopic Heller myotomy is a surgical procedure used to treat achalasia by dividing the muscle fibers of the lower esophageal sphincter (LES) to help relax the sphincter and improve swallowing function. It is performed using small incisions and specialized instruments, resulting in less post-operative pain and faster recovery compared to traditional open surgery.

The effectiveness and recovery associated with endoscopic balloon dilation, peroral endoscopic myotomy (POEM), and laparoscopic Heller myotomy can vary depending on factors such as the severity of the achalasia, the patient's overall health, and the expertise of the treating physician. Generally, all three treatments have been shown to be effective in relieving symptoms of dysphagia and improving swallowing function. Endoscopic balloon dilation may be less invasive but may require repeated procedures over time. POEM and laparoscopic Heller myotomy are more definitive treatments but may have slightly longer recovery times. POEM works well, but half of POEM patients will have acid reflux after the procedure, requiring medications or additional procedures.

The decision of which procedure to perform is complicated and depends on the severity of your symptoms, your overall health, and your treatment preferences. Your surgeon will evaluate your individual case and discuss the available treatment options with you to determine the most appropriate course of action.

We are the only group in the San Francisco Bay area which offers all three potential treatments for this condition, without having to visit several different specialists. Since we have experience with all of these treatments, we have a better understanding of how they function in different patients. This will give you the greatest number of options, allowing you to choose the smartest choice for you. Please make an appointment with us today to learn more!