Medically reviewed by Dr. Jihad Kudsi, MD
Achalasia is a rare swallowing disorder in which the lower esophageal sphincter does not relax properly and the esophagus loses its normal ability to move food toward the stomach. For someone in the western suburbs of Chicago dealing with worsening trouble swallowing, understanding what achalasia surgery in LaGrange, IL involves starts with understanding the condition itself.
Patients frequently spend months, sometimes years, attributing their symptoms to acid reflux or stress before a specialist identifies esophageal achalasia as the underlying cause. Getting an accurate diagnosis early matters because achalasia is treated very differently from reflux, and acid-reducing medication does not fix the underlying problem. Effective treatments exist, and the right one depends on the type of achalasia found on testing, your anatomy, and your overall health.
Key Takeaways
- Achalasia is a distinct swallowing disorder that is often mistaken for acid reflux until specialized testing clarifies the diagnosis.
- Diagnosis relies on a combination of upper endoscopy, a barium esophagram, and high-resolution esophageal manometry, not on symptoms alone.
- Treatment options include laparoscopic or robotic Heller myotomy with a partial fundoplication, peroral endoscopic myotomy (POEM), and pneumatic dilation. POEM and Heller myotomy give similar symptom relief in trials, but reflux is more common after POEM.
- Local access to specialized surgical evaluation in the LaGrange area allows patients to pursue diagnosis and treatment planning without traveling far from home.
What Is Achalasia and Why Can It Affect Swallowing?
Achalasia is a motility disorder of the esophagus that interferes with the muscle's ability to push food and liquid into the stomach. It centers on a specific valve at the base of the esophagus and creates a swallowing pattern distinct from ordinary acid reflux. Over time, food and saliva can pool in the esophagus, which may widen as a result.
The Role of the Lower Esophageal Sphincter
The lower esophageal sphincter (LES) is the ring of muscle at the junction between the esophagus and the stomach. It normally relaxes when a person swallows, allowing food to pass through, then tightens again to prevent stomach contents from moving backward. In achalasia, this relaxation is impaired, and the body of the esophagus also loses its normal coordinated, wave-like contractions (peristalsis), according to a state-of-the-art review in BMJ's clinical overview of esophageal achalasia.
Why Esophageal Achalasia Is Different From Acid Reflux
In gastroesophageal reflux disease (GERD), the sphincter relaxes too easily or too often, letting acid escape upward. Esophageal achalasia involves the opposite mechanical problem: a sphincter that will not relax when it should, trapping food and liquid above it. Acid-reducing medicine may ease some of the heartburn-like discomfort, but it does not treat the cause. This distinction is one reason patients with achalasia are sometimes misdiagnosed with reflux disease before a swallowing-specific workup is performed, as described in a review of achalasia diagnosis and management.
Achalasia Symptoms That Merit Specialist Evaluation
Achalasia symptoms often overlap with common digestive complaints, which is part of why the condition can go unrecognized for a period of time. Difficulty swallowing, regurgitation of undigested food, chest discomfort, nighttime coughing, and unintended weight loss are among the presentations that should prompt a closer look rather than continued self-treatment with over-the-counter remedies.
Difficulty Swallowing Solids and Liquids
Trouble swallowing both solid food and liquids, rather than solids alone, is a pattern that distinguishes achalasia from many other swallowing disorders. Patients often describe food sticking in the chest. The problem may develop gradually, leading people to eat more slowly, drink water with every bite, or avoid certain foods without recognizing the underlying cause.
Regurgitation, Chest Discomfort, Nighttime Cough, and Weight Loss
Regurgitation of food that never reached the stomach, chest pain or pressure, and coughing after lying down at night can all accompany achalasia. Regurgitated food can also be inhaled into the airway, which is why nighttime cough deserves attention. Because eating becomes difficult, some patients lose weight without trying. These symptoms may be mistaken for hiatal hernia or GERD-related complaints, particularly when they appear alongside heartburn-like sensations.
When Symptoms Should Not Be Attributed to GERD Alone
Symptoms should not be assumed to be GERD alone when swallowing difficulty involves both liquids and solids, or when regurgitation involves undigested food rather than acid. A clinical review notes that achalasia is commonly misdiagnosed as GERD because heartburn is a frequent early complaint, with many patients already on acid-reducing medication at the time achalasia is finally identified, according to research on achalasia diagnosis and management. Persistent symptoms despite reflux treatment warrant a specialist evaluation. Swallowing trouble that keeps getting worse, or that comes with weight loss, should be evaluated promptly, since other conditions, including esophageal cancer, can look similar and need to be ruled out.
How Is Achalasia Diagnosed?
Diagnosing achalasia requires a structured esophageal workup rather than a single test, since its symptoms overlap with several other conditions. Specialists combine endoscopy, imaging, and functional testing to confirm the diagnosis and to distinguish it from other causes of swallowing difficulty before any treatment conversation begins.
The Tests Used in a Complete Esophageal Workup
A complete evaluation typically includes three core tests, sometimes with additional studies:
- Upper endoscopy (EGD): a camera examination of the esophagus and stomach that looks for retained food and rules out structural causes such as a stricture or tumor.
- Barium esophagram: an X-ray swallow study that shows how well the esophagus empties and can reveal a dilated esophagus or a narrowed, "bird's beak" appearance at the sphincter.
- High-resolution esophageal manometry: a pressure study that measures sphincter relaxation and the coordination of esophageal contractions. It is the test that confirms achalasia and identifies its subtype.
In unclear cases, additional tests such as functional lumen imaging (EndoFLIP) may add information. Clinical literature emphasizes that a prolonged path to diagnosis is common when this stepwise evaluation is not pursued early, as discussed in research on the prolonged path to achalasia diagnosis.
Ruling Out Other Causes of Swallowing Problems
Because swallowing difficulty can stem from structural, inflammatory, or motility causes, specialists work to exclude other explanations before confirming achalasia. Certain tumors near the junction of the esophagus and stomach can mimic achalasia, which is one reason endoscopy, and sometimes additional imaging, is part of every workup. This step protects patients from pursuing achalasia-specific treatment when a different condition is responsible for their symptoms.
Using Test Results to Guide Treatment Planning
Manometry classifies achalasia into three subtypes. Types I and II involve absent peristalsis, and type III involves spastic contractions. Modern classification systems, developed from advances in esophageal testing, allow specialists to describe these subtypes with more precision than in past decades, according to a review of modern achalasia diagnosis and classification. The subtype, along with findings such as a hiatal hernia or an esophageal diverticulum, helps the surgical team decide which treatment fits best.
What Are the Treatment Options for Achalasia?
Achalasia treatment does not restore normal esophageal peristalsis. Instead, every option works by opening or weakening the tight lower esophageal sphincter so that food can pass into the stomach. The main options are laparoscopic or robotic Heller myotomy with a partial fundoplication, POEM, and pneumatic dilation, and the right choice depends on the achalasia subtype, individual anatomy, symptom severity, and prior treatment history. A gastric and esophageal surgery evaluation helps sort through these choices.
When Heller Myotomy May Be Considered
Heller myotomy may be considered for patients whose esophageal testing confirms achalasia and who are appropriate candidates for surgery. It is often favored when a patient also has a hiatal hernia or an esophageal diverticulum, because these can be repaired during the same operation. The decision involves weighing achalasia subtype, esophageal anatomy, prior treatments, and a patient's overall health with their surgical team.
Laparoscopic or Robotic Heller Myotomy
Heller myotomy is performed through several small abdominal incisions using laparoscopic or robotic techniques. The surgeon divides the muscle fibers of the lower esophageal sphincter and the lowest part of the esophagus, then adds a partial fundoplication to protect against reflux. In a randomized trial comparing POEM with laparoscopic Heller myotomy, the surgical group underwent Heller myotomy with a Dor fundoplication, according to the American College of Gastroenterology's summary.
POEM and Other Nonsurgical or Endoscopic Options
POEM (peroral endoscopic myotomy) is an endoscopic alternative to traditional surgery, performed through the mouth without external incisions. In a randomized trial of 221 patients, symptom control at two years was similar after POEM (83%) and laparoscopic Heller myotomy (82%), but reflux esophagitis was more common after POEM (44% vs 29%), and more of those patients needed acid-suppressing medication, according to an NEJM Journal Watch summary of the trial. Five-year follow-up data have since been published in The Lancet Gastroenterology & Hepatology. Professional society guidelines now treat POEM as a comparably effective first-line option for type I and II achalasia and a preferred option for type III, per the same American College of Gastroenterology summary.
Other nonsurgical options include pneumatic dilation, in which a balloon stretches the sphincter and which may need to be repeated, and botulinum toxin injection, whose effect is short-lived and which is generally reserved for patients who cannot undergo other treatments.
The Role of Fundoplication After Myotomy
Cutting the sphincter muscle weakens the natural barrier against acid reflux, so a partial fundoplication, such as a Dor or Toupet wrap, is commonly added to Heller myotomy. A partial wrap is used rather than a full wrap so that food can still pass easily. This combination approach is a recognized part of surgical planning for eligible patients and is discussed as part of a broader gastroesophageal reflux disease treatment conversation.
Finding Individualized Achalasia Care in LaGrange
Patients in the western suburbs of Chicago can access specialized evaluation for achalasia through Dr. Jihad Kudsi's practice, which focuses on metabolic and digestive surgery. Dr. Kudsi is double board-certified in General Surgery and Obesity Medicine and is fellowship-trained. He is Medical Director of Bariatric Surgery at UChicago AdventHealth's Bariatric and Obesity Medicine Clinic in LaGrange, and more background on his training and clinical focus is available on his physician profile.
His practice, Chicago Metabolic & Digestive Surgery Center, evaluates patients for a range of conditions treated, including achalasia evaluation and surgery, hiatal hernia, and gallbladder disease. Alongside general surgery, his experience includes metabolic surgery procedures such as sleeve gastrectomy, gastric bypass, and duodenal switch. Patients whose symptoms involve overlapping concerns, such as reflux or obesity, may also benefit from a review of medical weight management options as part of a broader care plan.
Coordination with local hospital resources, including UChicago Medicine AdventHealth La Grange, supports imaging, testing, and any inpatient care that a treatment plan may require. The practice serves patients from LaGrange and surrounding western suburbs.
Scheduling a consultation at UChicago AdventHealth's Bariatric and Obesity Medicine Clinic in LaGrange, 5101 S Willow Springs Road, LaGrange, IL 60525, allows patients to review their symptoms and testing history directly with the surgical team. Bringing prior endoscopy, barium swallow, and manometry reports helps make the visit more productive. Appointments can be requested by calling or through the practice's contact page.
Conclusion
Achalasia requires a distinct diagnostic and treatment approach that differs from standard acid reflux care, starting with recognizing symptoms like difficulty swallowing both solids and liquids. A complete esophageal workup, including endoscopy, a barium esophagram, and high-resolution manometry, helps rule out other conditions and clarifies which treatment path, whether laparoscopic or robotic Heller myotomy with partial fundoplication, POEM, or another option, fits a patient's presentation. Local access to a fellowship-trained surgical team in LaGrange gives patients in the Chicago area a practical starting point for that evaluation.
Frequently Asked Questions
Achalasia treatment involves a handful of established surgical and endoscopic approaches, with the answers below addressing how they relate to each other and what recovery generally involves.
What is the name of surgery for achalasia?
The most established surgical procedure for achalasia is called Heller myotomy, which can be performed using laparoscopic or robotic techniques. It involves dividing the muscle fibers of the lower esophageal sphincter and the lowest part of the esophagus to ease the passage of food into the stomach, usually with a partial fundoplication added to protect against reflux.
Is Heller myotomy the same as POEM?
Heller myotomy and POEM (peroral endoscopic myotomy) both address the same underlying muscle problem but use different approaches. Heller myotomy is performed through small abdominal incisions, while POEM is performed endoscopically through the mouth without external incisions. Randomized trial data show similar symptom relief at two years, but reflux esophagitis is more common after POEM because no antireflux wrap is added, so patients often need reflux monitoring or acid-suppressing medication afterward.
Why is fundoplication sometimes performed with Heller myotomy?
A partial fundoplication is added to Heller myotomy to reduce the risk of acid reflux that can develop after the sphincter muscle is divided. Not every patient is treated identically, and the decision depends on individual anatomy and surgical findings.
How long does recovery from achalasia surgery usually take?
Recovery varies with the procedure and the patient, but many patients go home within one to two days after laparoscopic or robotic Heller myotomy or POEM. Most begin with liquids and advance to soft foods over roughly two weeks before returning to a regular diet, and many return to desk work within one to two weeks. Your surgical team will give you specific instructions based on your procedure and health.
Can achalasia symptoms return after treatment?
Symptoms can persist or recur after treatment in some patients, since achalasia is a chronic motility condition rather than one with a single permanent fix. Ongoing follow-up with a specialist helps monitor symptom patterns and reflux, and determine whether additional intervention, such as repeat endoscopic treatment or revision surgery, is appropriate over time.
Is untreated achalasia dangerous?
Yes, it can be. Over time, untreated achalasia can lead to worsening swallowing difficulty, weight loss and poor nutrition, a widened esophagus, and inhaled food that causes lung infections. Long-standing achalasia is also associated with a small increase in the long-term risk of esophageal cancer, so follow-up with a specialist matters even after symptoms improve.
What should I bring to an achalasia consultation?
Bring any prior endoscopy, barium swallow, and manometry reports, a list of medications you have tried for reflux, and notes on when your symptoms started and how they have changed. A surgeon can then decide which additional tests, if any, are needed before recommending treatment.
