Journal of Hepatology and Gastrointestinal disorders
Open Access

Role of Barium Swallow Studies and Balloon Dilation in Achalasia

Francesco Falconi^{* *}Correspondence: Francesco Falconi, Department of Gynecology, Sapienza University, Rome, Italy, Email:

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About the Study

Achalasia is a rare yet impactful esophageal disorder characterized by the malfunction of the Lower Esophageal Sphincter (LES), which fails to relax properly, impeding the smooth passage of food into the stomach. This condition leads to a range of distressing symptoms, including difficulty swallowing, regurgitation of undigested food, and chest pain. As the esophagus gradually dilates and loses its motility, individuals often experience progressive discomfort and nutritional challenges. Diagnosing achalasia involves a combination of specialized tests such as esophageal manometry, barium swallow studies, and endoscopy. While there is no definitive cure, advancements in treatment including medications, balloon dilation, and innovative surgical techniques like Peroral Endoscopic Myotomy (POEM) offer significant relief. Understanding achalasia requires a comprehensive approach to manage symptoms effectively and improve patient’s quality of life, making research and customized care necessary for better outcomes.

Swallowing issues related to achalasia

Achalasia extremely disrupts the swallowing process by impairing the normal function of the Lower Esophageal Sphincter (LES). In a healthy esophagus, the LES relaxes to allow food and liquid to pass into the stomach. However, in achalasia, the LES remains constricted and fails to open properly. This malfunction causes food and liquids to become trapped in the esophagus, leading to difficulties with swallowing (dysphagia). As a result, individuals often experience a sensation of food sticking in the chest or throat, regurgitation of undigested material, and discomfort. The esophagus may also become dilated and stretch over time due to the persistent pressure from trapped food. This compromised swallowing function can significantly affect nutritional intake and overall quality of life, making effective management and treatment important for alleviating symptoms and restoring normal swallowing function.

Role of barium swallow studies

Its play a significant role in diagnosing achalasia by providing detailed images of the esophagus in motion. During this test, patients drink a barium sulfate contrast liquid, which coats the esophagus and highlights its structure on X-ray images. As the barium moves through the esophagus, real-time imaging reveals how effectively the Lower Esophageal Sphincter (LES) relaxes and how well food progresses toward the stomach. This diagnostic tool helps identify characteristic signs of achalasia, such as esophageal dilation and impaired LES relaxation. It also aids in differentiating achalasia from other esophageal disorders by providing visual evidence of the swallowing process and identifying areas of obstruction or abnormal motility. The insights gained from barium swallow studies are vital for formulating an accurate diagnosis and tailoring appropriate treatment strategies for managing achalasia effectively.

Balloon dilation

It is a minimally invasive procedure used to treat achalasia by widening the narrowed Lower Esophageal Sphincter (LES). During the procedure, a balloon catheter is inserted through an endoscope into the esophagus. The balloon is then gradually inflated at the level of the LES. As the balloon expands, it exerts pressure on the sphincter, stretching and breaking apart the muscle fibers. This process helps to relieve the obstruction and allows for improved passage of food and liquids into the stomach. Balloon dilation aims to restore normal esophageal function and alleviate symptoms such as difficulty swallowing and regurgitation. The procedure is typically performed on an outpatient basis and may require repeat sessions for optimal results. Post-procedure, patients often experience significant symptom relief and improved quality of life, though regular follow-up is necessary to monitor effectiveness and identify any recurring issues.

Heller myotomy

It is a surgical procedure designed to treat achalasia by analyzing the dysfunction of the Lower Esophageal Sphincter (LES). During this operation, the surgeon makes small incisions in the abdominal wall to access the esophagus, often using laparoscopic techniques. The procedure involves cutting the muscles of the LES to relieve the pressure that impedes the passage of food and liquids into the stomach. This muscle division helps restore normal esophageal function and alleviate symptoms such as difficulty swallowing and regurgitation. Heller myotomy is typically followed by a partial fundoplication, where the top of the stomach is wrapped around the esophagus to prevent acid reflux. The surgery is usually effective in improving swallowing and overall quality of life, though some patients may require additional interventions or medications. Postoperative care includes dietary adjustments and regular follow-up to ensure successful outcomes and monitor for potential complications.