It is a motility disorder of the esophagus (your food pipe) in which the lower sphincter (valve) fails to relax. This presents as difficulty swallowing to both liquids and solids. It causes progressive enlargement of the esophagus above the sphincter and weakening of the esophageal contractions over the long term.
This is best confirmed after history with a barium swallow showing “Bird beak” appearance of the esophagus and ultimately esophageal Manometry showing the failed relaxation of the lower sphincter.
Multiple modalities of treatment exist. Medical therapy can initially help, but usually fails eventually. Endoscopic Botox injections have a good short-term success, especially for patients who cannot undergo an operation. Endoscopic dilatation can have a god long-term outcome in selected patients with the proper technique and carried out by our gastroenterologist with great success. Ultimately, Surgical Myotomy (Heller’s Myotomy) of the lower esophagus has the best long-term success rate, and is done laparoscopically which eases the recovery of the patient. The video below can help illustrate the technique better.