How is Achalasia Diagnosed?
DiagnosisA key feature of achalasia care at NewYork-Presbyterian is our team approach. Surgeons and gastroenterologists use minimally invasive surgical and endoscopic techniques to treat this condition.
The diagnosis of achalasia requires specialized “motility testing” to see how well your esophagus is working to move food down toward your stomach. At NewYork-Presbyterian, our state-of-the-art motility labs use the latest techniques to determine the exact cause of your swallowing difficulty.
Some of the techniques we use for achalasia diagnosis include:
- Upper endoscopy or Esophagogastroduodenoscopy (EGD): During an EGD, a gastroenterologist inserts a flexible camera through your mouth to look at your esophagus, stomach, and small bowel for any abnormalities. A small sample of your body tissue—called a biopsy—will be taken if needed.
- Endoluminal functional lumen imaging (EndoFLIP): During an endoscopy, a small balloon is inserted that can measure the dimensions and movement of the esophagus as well as the ability of the lower esophageal sphincter to open.
- High-resolution esophageal manometry: This test measures the pressure, strength, and coordination of the muscles in your esophagus. A thin tube is passed through your nose and down into your stomach. We then measure how well your esophagus muscle functions while you swallow sips of liquid. Manometry assesses the function and relaxation of your lower esophageal sphincter.
- Esophagram: In this test, you are given liquid barium, and X-rays are taken to evaluate your swallow and entire esophagus as it empties into your stomach. You may also be given a tablet, with X-rays taken, to assess if it passes.
How is Achalasia Treated?
TreatmentMany achalasia treatments are available that depend on the patient’s preference and type of achalasia. Treatments aim to open the lower esophageal sphincter (LES) to allow the esophagus to empty. Your care team will evaluate your symptoms and choose the most appropriate treatment.
Treatments for achalasia can include:
- Peroral Endoscopic Myotomy (POEM): At NewYork-Presbyterian, we offer an innovative treatment for achalasia called peroral endoscopic myotomy (POEM), which is only available at medical centers with the expertise and resources to provide such advanced therapies. While you are fully sedated under general anesthesia, an advanced endoscopist uses a flexible camera (endoscope) to cut the abnormal muscles in the lower esophageal sphincter and allow the esophagus to empty more normally. This whole procedure is done through the mouth and does not require any cuts on the outside of the body. Some patients may be able to go home the same day.
- Heller myotomy with fundoplication: In this surgery, a surgeon makes small incisions in your abdomen to cut thlower esophageal sphincter muscles, allowing food to pass more easily into your stomach. To prevent reflux after the procedure, the surgeon typically performs a partial “wrap” of the stomach around your esophagus called a fundoplication. In some cases, this procedure may be performed using robotic surgery.
- Pneumatic balloon dilation: During an endoscopy, the lower esophageal sphincter can be dilated using a specially designed large balloon placed into the esophagus.
- Botulin toxin (Botox) injection of the lower esophageal sphincter can help improve esophageal emptying by causing the sphincter to relax. The results are temporary and are only reserved for patients unable to undergo the above procedures or for diagnostic purposes.
Trust NewYork-Presbyterian for Achalasia Treatment
Not all medical centers have clinicians with experience diagnosing and treating achalasia. Various treatments are available to help you treat and manage your achalasia symptoms.
At NewYork-Presbyterian, we are experienced in offering all achalasia therapies, including the latest approaches, and will match you with an expert in esophageal disorders. Call us today to make an appointment so you can start feeling better