Balloon Dilatation in Achalasia

By: Jehannah Dayanara B. Hayudini

What is ACHALASIA?

• Achalasia is an esophageal motor disorder

characterized by increased lower esophageal sphincter
(LES) pressure, diminished-to-absent peristalsis in the
distal portion of the esophagus composed of smooth
muscle, and lack of a coordinated LES relaxation in
response to swallowing.
Types of Achalasia:

• Type I Achalasia
- shows absence of any motility and contraction within the
body of the esophagus

• Type II
- shows simultaneous contractions

• Type III
- reveals a simultaneous high-pressure spasm
What causes achalasia?

• The cause of achalasia is unknown. Theories on

causation invoke infection, heredity or an abnormality
of the immune system that causes the body itself to
damage the esophagus (autoimmune disease).
SYMPTOMS:

•Backflow (regurgitation) of food

•Chest pain
•Cough
•Difficulty swallowing liquids and solids
•Heartburn
•Unintentional weight loss
How is achalasia diagnosed?

• X-ray studies
• Esophageal manometry
• Endoscopy
What is the treatment for achalasia?

• oral medications
• stretching of the lower esophageal sphincter (dilation)
• surgery to cut the sphincter (esophagomyotomy)
• injection of botulinum toxin (Botox) into the sphincter
Oral medications

• Oral medications that help to relax the lower

esophageal sphincter include groups of drugs called
nitrates, for example, isosorbide dinitrate (Isordil)
and calcium channel blockers (CCBs), example,
nifedipine (Procardia) and verapamil (Calan).
Botulinum toxin

• Injection is quick, nonsurgical, and requires no

hospitalization.
• Botox injection takes 10 min and blocks the spasm of
the lower esophageal sphincter. The effect lasts for 3
months, consequently the therapy has to be repeated.
• Injection is a good option for patients who are very
elderly or are at high risk for surgery, for example,
patients with severe heart or lung disease.
• This may reduce post-surgical complications.
Dilation

• Dilation of the lower esophageal sphincter is done by

having the patient swallow a tube with a balloon at the
end. The balloon is placed across the lower sphincter
with the help of X-rays, and the balloon is blown up
suddenly. The goal is to stretch--actually to tear--the
sphincter.
• Dilation is a quick and inexpensive procedure
compared with surgery, and requires only a short
hospital stay.
Esophagomyotomy

• Surigical cutting of sphincter .

• The surgery can be done using an abdominal incision or
laparoscopically through small punctures in the
abdomen.
Thank
You ! :)