Achalasia Surgery

Achalasia is a rare condition that affects the nerves that control the sphincter muscles (valve) in the lower oesophagus making it hard to move food into your stomach.

Achalasia is a rare condition affecting about 1 in 100,000 people where the nerves which help the lower oesophageal sphincter to relax have been destroyed by an autoimmune process. The sphincter fails to relax properly when food is swallowed and so the food can get stuck or find it very difficult to enter the stomach.

Mr Sanjeeva Kariyawasam
Achalasia Specialist, Perth

What is achalasia?

Achalasia is a rare swallowing disorder that makes it hard for food or liquid to pass from your oesophagus into your stomach.

Achalasia Surgery

Achalasia symptoms include difficulty swallowing, chest pain or discomfort, weight loss and regurgitation.

What are the symptoms of achalasia?

Achalasia can be similar to other conditions such as acid reflux or oesophageal cancer. You may experience a sensation of food sticking, chest pain, weight loss and heartburn. But there are some other key symptoms to watch out for.
"When you have achalasia you typically will have trouble swallowing. You will feel as though food is stuck in your chest and builds up. You will often regurgitate food or vomit after eating."
Mr Sanjeeva Kariyawasam
Achalasia Specialist, Perth
"Achalasia is a rare condition affecting about 1 in 100,000 people. In this condition the nerves which cause the oesophageal sphincter to relax are destroyed. The muscles in the oesophagus work harder to try and get food through into the stomach and eventually may stop working. As a result, patients have a sensation of food getting stuck, they can also get pain and lose weight. Over time the condition can progress and oesophagus can stretch and become totally flaccid. There is also an increased risk of aspiration and of oesophageal cancer developing, so regular follow up is essential."
Assoc Prof Mo Ballal
Achalasia Specialist, Perth

How do we diagnose achalasia?

Achalasia diagnosis requires more than a simple check-up. Because symptoms can be similar to other conditions, our achalasia specialists are likely to recommend:

Oesophageal manometry

This is a gold-standard test that assesses the motor function of your oesophagus. A thin plastic tube is passed through your nose or mouth into your oesophagus. Sensors measure the pressure your oesophageal muscles produce when relaxed and when swallowing water.

Barium swallow

You’ll be asked to drink a liquid with barium in it. X-rays are then taken to follow the liquid as it passes through your oesophagus into your stomach. If you have achalasia, the x-rays will show an enlarged oesophagus which narrows at the lower end. The liquid barium will not pass (or pass very slowly) into your oesophagus.


This lets the specialist see inside the oesophagus. Common findings are of a dilated (stretched) oesophagus with undigested food at its lower end.

Key Points

Achalasia can affect anyone, but has 2 peaks in people aged in their 20's and in those in their 60's
It gets progressively worse over time
Early treatment can help to reduce symptoms and avoid other health complications

Achalasia surgery

There are a number of procedures that can be performed to allow easier passage of food and fluids into the stomach.

Endoscopic options include dilating the lower oesophageal sphincter (LES) with a balloon and/or relaxing the muscle by injecting Botox.

For many years the Gold Standard approach has been a keyhole or laparoscopic procedure that can be done through small incisions in the abdominal wall to divide the oesophageal muscle.

Most recently a complex endoscopic procedure known as a Per-Oral Endoscopic Myotomy (POEM) allows the procedure to be performed through the mouth and dividing the oesophageal muscle from the inside.

"The newest technique which is rapidly gaining popularity amongst specialist and also patients is a per-oral endoscopic myotomy or POEM. This is considered a scarless operation as the myotomy is all done through the mouth and no cuts on the skin are necessary. Multiple studies have shown this technique to be safe and effective."
Mr Sanjeeva Kariyawasam
Achalasia Specialist, Perth
Your specialist will discuss all treatment option with you including the risks and benefits of each approach.

What to expect from achalasia surgery?

Almost 95% of people who undergo surgery get some relief from symptoms. Our surgeons are specialised in upper-gastrointestinal surgery and have additional training in this complex area of oesophageal disorders .

You are in expert hands at Upper GI West and we will offer you the highest quality surgical care. Our five surgeons have experience treating conditions such as achalasia, and we work with you to ensure the best outcomes.

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