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What is Achalasia?

Achalasia is a motility disorder of the esophagus that makes it difficult for food and liquid to pass into your stomach. It results from the inability of the esophagus to squeeze food down (peristalsis) and from insufficient relaxation of a muscular valve (lower esophageal sphincter) located between the esophagus and stomach.

Genetic, infectious, and autoimmune mechanisms have been proposed, as the probable etiology of achalasia. Patients with autoimmune conditions like lupus, tend to be at a higher risk.

Achalasia Symptoms

  • Difficulty swallowing
  • Chest pain
  • Heartburn
  • The sensation of food retention.
  • Regurgitation or backflow of undigested food from the esophagus into the mouth.
  • Unintentional weight loss. 


Achalasia symptoms can progress from occasional to daily symptoms.

Diagnosis for Achalasia

Frequently, achalasia is misdiagnosed because of similar symptoms to gastroesophageal reflux. High-resolution manometry is the best test to diagnose achalasia. This test measures the motility (squeezing/peristalsis) of the esophagus and how well the muscular valve located between the esophagus and stomach relaxes. Moreover, it will define which type of achalasia you have. It is strongly recommended that patients with achalasia undergo an upper endoscopy to evaluate the shape of the esophagus and a barium esophagram.

Dr. Arevalo has expertise in treating achalasia using the latest technology. He frequently presents at international meetings about the achalasia treatment, where he explains about the Per Oral Endoscopic Myotomy surgery, also known as the POEM surgery.

Achalasia Treatment

Management options for achalasia include: 

  • Medications (nitrates and calcium-channel blockers), however, these have poor effects.
  • Endoscopic BOTOX injections and Pneumatic dilations of the LES valve requires repeated interventions, because of its decreased durability in controlling achalasia symptoms. Each of these therapies has a specific indication and patient selection. 
  • A less invasive alternative for surgery is the POEM procedure. With this surgery, there is NO incision in the chest or abdomen. The POEM surgery is performed by standard endoscopy. The endoscope passes through the patient's mouth into the esophagus. The musculature valve (sphincter) between the esophagus and the stomach is identified and is partially divided. This helps relax the lower esophageal sphincter allowing food to pass more easily into the stomach. The small incision in the inside lining of your esophagus is closed using endoscopic clips, an advanced technology.
Acalasia
PonskyJL, et al. J GastrointestSurg. 2012
POEM procedure was introduced in 2008 and has demonstrated to be safe and effective, with short recovery times and fewer complications when compared to the antique Laparoscopic Heller Myotomy.

Dr. Arevalo is among the few Houston surgeons to perform this novel and advance technique poem surgery.

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