A/Prof David van der Poorten
Dr Roslyn Vongsuvanh
  Prof Golo Ahlenstiel
Dr Way Siow

Appointments & Enquiries:  (02) 8711 0160

Achalasia Management

 

Achalasia is a rare swallowing disorder of the oesophagus that leads to progressive inability to swallow both solids and liquids. The underlying cause of achalasia is unknown. The disease causes degeneration of the nerves in the oesophageal wall, leading to loss of normal peristalsis (contractions) and inability of the lower oesophageal sphincter to open.

Diagnosis is based on the history, findings on Barium swallow, Oesophageal Manometry and Endoscopy.

achalasia-swallow1
achalasia-swallow2

 

Specialised Services Provided

 

Pneumatic Balloon Dilation

Dilation of the lower oesophageal sphincter with a view to tearing the muscle fibres and leaving the oesophagus open is as effective as surgery and is significantly safer. Pneumatic Balloon dilation leads to improvement in symptoms in over 85% of patients and can be repeated in the future if necessary. We perform this specilised procedure as day surgery in the public and private system.

achalasia-dilation

 

Quick Case Study

A man in his 50’s was diagnosed with Achalasia in 2008 and underwent a surgical myotomy to the lower oesophageal sphincter through another doctor. In late 2011 he had been unable to swallow for over 3 months and had lost close to 30kg in weight. When admitted to Westmead under my care he weighed just 43kg. A pneumatic balloon dilation was performed and his swallowing was instantly improved. In the space of 2 months he was back to 65kg and feeling well. He has subsequently had two further balloon dilations and can now eat more or less what he wants.

 

Botox Injection

achalasia-botoxBotulinum toxin (Botox) works by temporarily paralysing muscle for between 4-12 months. (and its not just for celebrities that want to look surprised!) When injected into the lower oesophageal sphincter muscle at endoscopy, it opens up the oesophagus and allows the food to pass. It is an excellent treatment for achalasia in people who are at too high a risk for pneumatic balloon dilation or surgery. The procedure is performed as day surgery at the time of endoscopy and can be done through the public or private system. The botox must be purchased and paid for privately on the day of procedure.

 

Quick Case Study

An 81 year old lady was admitted under my care at Westmead hospital with dehydration secondary to recurrent vomiting. She had been unable to swallow any solids or liquids for the past week, having had a progressive reduction in her swallowing over a few months. Achaslia was diagnosed following Barium swallow, CT scan and oesopahgeal manometry. She was treated with Botox injection to the lower oesophageal sphincter and her swallowing improved within 48hrs.  Over the last 4 years she has had Botox injections repeated every 6-9 months, or when she is starting to find her swallowing more difficult. She rarely if ever vomits these days.