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May 22, 2012 > Feel Like Food Gets Stuck in Your Chest? It May Be Achalasia

Feel Like Food Gets Stuck in Your Chest? It May Be Achalasia

Do you or someone you know have difficulty swallowing? Does it feel like food gets stuck in the middle of your chest? This could be caused by a condition called achalasia, which can occur when food is unable to pass normally through the lower esophageal sphincter. That's the muscular ring located between your esophagus and stomach.

"With achalasia, the lower esophageal sphincter, or valve, is too tight and fails to relax. So, food backs up and the esophagus begins to look like a funnel. That's what causes the feeling of blockage in the mid-chest," explained Mary S. Maish, M.D., chief of thoracic and foregut surgery for Washington Township Medical Foundation. "When this happens, people have to wait for the valve to release, and then the food trickles down into the stomach."

Achalasia generally affects people during young adulthood and again in their late 30s or 40s. The cause is not known, but doctors believe it may be due to a virus, or it may be genetic. Achalasia is not a common condition, affecting about one or two people in every 200,000, but it can be very uncomfortable.

Most people with this problem begin by having trouble swallowing solid foods. Then, the difficulty progresses to softer foods. Eventually, they even have trouble swallowing liquids. Some people lose weight because of the difficulty eating.

Achalasia can sometimes be confused with gastroesophageal reflux disease (GERD) or hiatal hernia. To diagnose the problem, doctors order two tests. The first is a barium swallow, in which the patient swallows a barium solution and X-rays are taken, allowing the doctor to see if the esophagus is opening properly to allow the solution to flow through.

The second test is called an esophageal manometry. A thin tube, or catheter, is placed into the esophagus through the nose, and the pressure in the lower esophagus is measured while the patient swallows. This determines if the lower esophagus is relaxed or too tight.

"There are several ways to treat achalasia, but surgery is by far the most effective," advised Dr. Maish.

She performs a minimally invasive laparoscopic procedure to cut the muscle attached to the lower esophageal sphincter. This allows the valve to relax so food can pass through. After the surgery, patients are usually able to go home from the hospital the next day.

When the valve is cut this way, there is no longer a barrier between the esophagus and stomach, and food can easily pass down toward the stomach and up toward the throat. This means, after the procedure, some people may have problems with reflux or heartburn. In that case, it may be necessary for the doctor to perform a second minimally invasive procedure called a laparoscopic fundoplication to reinforce the closing function of the lower esophageal sphincter.

"This procedure usually takes about an hour and the patient stays in the hospital one night," Dr. Maish says. "The next day, we do a barium swallow test to confirm that the esophagus is working well."

After surgery for achalasia, patients are usually eating normally within a couple of weeks. Some people will have mild episodes of heartburn, which can be treated with antacid medications.

There are two other options for treating achalasia. One is an injection of Botox into the lower esophageal valve. To perform the injection, the doctor visualizes the valve using an endoscope, a device with a light attached that is inserted through the esophagus. The other treatment option involves inserting and expanding a small balloon to dilate or stretch the valve.

"Both of these procedures are usually temporary measures and often fail within six months to a year, so they have to be repeated," reports Dr. Maish. "That's why I don't usually recommend them, unless there is a strong reason the patient can't have surgery."

"My patients with achalasia have had very good, long term effects from the minimally invasive procedure," she continues. "For more than 90 percent, they continue to experience good results 10 years later."

Dr. Maish is board certified in both general and thoracic surgery and emphasizes minimally invasive approaches in all aspects of her clinical practice. She attended medical school at Rush Medical College in Chicago and completed her General Surgery residency at a hospital affiliate of the University of Pennsylvania. After completing her training, she was the Roddy Scholar in cardiothoracic research at Brown University and obtained a Master's in Public Health from Harvard University.

Afterwards, she was trained in thoracic surgery at Baylor College of Medicine/MD Anderson Cancer Center in Houston, Texas, and performed an esophageal/foregut fellowship at the University of Southern California. Before starting her practice in Fremont, she founded and directed the Center for Esophageal Disorders.

Learn more

For more information about achalasia, go online to www.ncbi.nlm.nih.gov, the Web site of the U.S. Library of Medicine, and search under Diseases and Conditions. To learn more about Mary S. Maish, M.D., go to www.mywtmf.com.

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