Esophageal Achalasia: Advanced Diagnosis and Treatment with POEM Technique
Complete information on symptoms, diagnosis and minimally invasive treatment of achalasia by advanced endoscopy specialist
Anatomical representation of esophageal achalasia
Quick Summary - What Matters Most
🎯 What is Achalasia?
- • Rare disease affecting esophageal motility
- • Lower esophageal sphincter doesn't relax properly
- • Causes difficulty swallowing (dysphagia)
- • Has effective treatment solutions
⭐ POEM Treatment:
- • Revolutionary technique minimally invasive
- • 90% success rate in symptom control
- • 24 hours typical hospitalization
- • No external incisions or scars
What is Esophageal Achalasia?
Esophageal achalasia is an uncommon but significant disease affecting the esophagus, the tube connecting the mouth to the stomach. This condition, which can severely impact patients' quality of life, requires accurate diagnosis and specialized treatment.
As a specialist in advanced endoscopy at Hospital Universitario La Paz and INMEQ, I have dedicated much of my career to perfecting minimally invasive techniques to treat this complex disease.
Technical Definition
Esophageal achalasia is a primary esophageal motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax properly during swallowing.
This condition is accompanied by loss of normal esophageal peristalsis, resulting in significant difficulty for food and liquids to pass from the esophagus to the stomach.
Epidemiological Data
cases per 100,000 inhabitants/year
typical age of presentation
male/female distribution
The exact cause remains unknown, although autoimmune, genetic and possibly infectious factors are believed to intervene, leading to degeneration of esophageal nerve cells.
Main Symptoms of Achalasia
Patients with esophageal achalasia present a constellation of symptoms that can develop gradually over months or years. Early recognition of these symptoms is fundamental for timely diagnosis and treatment:
Progressive Dysphagia
The most characteristic symptom is difficulty swallowing, which may initially manifest only with solid foods and progressively include liquids. Patients describe the sensation that food "gets stuck" in the chest.
Regurgitation
Regurgitation of undigested food is frequent, especially during nighttime hours. This symptom can lead to respiratory complications from aspiration.
Chest Pain
Many patients experience retrosternal chest pain, which can be confused with cardiac problems. This pain is usually more intense after meals.
Weight Loss
Difficulty eating adequately inevitably leads to significant weight loss, which may be the symptom that prompts the patient to seek medical attention.
Respiratory Symptoms
Aspiration of regurgitated content can cause nocturnal cough, recurrent pneumonia and other respiratory problems.
Real Testimonial: José Luis's Experience
José Luis
Patient treated with POEM technique
Before treatment:
"I was in bad shape, I had episodes where I couldn't swallow, couldn't eat and eventually much worse. I couldn't even drink, that is, I couldn't nourish myself in any way... Above all a sensation like choking, of impossibility to swallow and having to completely stop eating."
After POEM treatment:
"Now very well, very happy because I've recovered that, something I didn't give importance to before, like eating normally... I feel as good since the operation, which was a month ago, as before having any symptoms. I'm very well, really."
Full video testimonial:
Message for other patients
"I believe they shouldn't be afraid. At least my experience has been very good and it has only meant positive things for me."
Diagnosis of Esophageal Achalasia
Diagnosing achalasia requires a multidisciplinary approach combining clinical evaluation with specialized studies. Accurate diagnosis is fundamental for selecting the most appropriate treatment:
1. Clinical Evaluation
A detailed clinical history is fundamental. Typical symptoms, especially progressive dysphagia and regurgitation, should alert the clinician to the possibility of achalasia.
2. Imaging Studies
Barium esophagram is one of the most informative studies, showing the characteristic "bird's beak" at the esophagogastric junction, esophageal dilation and absence of peristalsis.
3. Upper Endoscopy
Endoscopy allows evaluation of esophageal mucosa, ruling out malignant lesions and assessing the degree of esophagitis. It is essential for differential diagnosis.
4. Esophageal Manometry - Gold Standard
Considered the gold standard for diagnosis, high-resolution manometry allows classification of achalasia into different subtypes according to the Chicago Classification, which has important therapeutic implications.
This classification determines prognosis and guides selection of the most appropriate treatment for each patient.
Chicago Classification of Achalasia
The Chicago Classification divides achalasia into three main subtypes based on manometric findings. This classification is crucial for determining the most appropriate therapeutic approach:
Type I
Classic Achalasia
Complete absence of esophageal peristalsis
Type II
Achalasia with Compression
Presence of panesophageal pressurization
Type III
Spastic Achalasia
Premature (spastic) contractions
Important: Type II achalasia has the best prognosis with any treatment, while type III may require more specialized techniques such as POEM with extended myotomy.
Treatment Options for Achalasia
There are several therapeutic options for achalasia, each with its advantages and limitations. The goal of all treatments is to reduce lower esophageal sphincter pressure to facilitate food passage:
Medical Treatment
Medications such as nitrates and calcium channel blockers can provide temporary relief, but their efficacy is limited and they don't represent a long-term solution.
Pneumatic Dilation
Forced dilation of the lower esophageal sphincter can be effective, but requires multiple procedures and carries risk of esophageal perforation.
Laparoscopic Myotomy (Heller)
Laparoscopic surgery has been the gold standard for years, but requires abdominal incisions and a longer recovery period.
POEM Technique: The Revolution in Achalasia Treatment
Peroral endoscopic myotomy (POEM) represents a revolutionary advance in treating esophageal achalasia. This innovative technique, which I learned during my fellowship at Northern Yokohama Hospital in Japan in 2013, from the creator of the technique, Prof. Haruhiro Inoue, offers significant advantages over traditional methods.
POEM combines the benefits of minimally invasive surgery with the precision of advanced endoscopy, allowing effective treatment without external incisions. For more detailed information, you can visit our specific page on POEM in achalasia.
Watch how the POEM procedure is performed step by step:
Key points of the procedure:
- • Injection of blue substance to protect deep layers of the esophagus
- • Creation of submucosal tunnel to the gastric cavity
- • Selective section of circular fibers causing dysphagia
- • Closure of incision with endoclips that naturally fall off in 2-3 weeks
Advantages of POEM Technique:
Minimally Invasive
Requires no external incisions or visible scars. Everything is done orally.
Rapid Recovery
Typical hospital stay of 24-48 hours, return to activities in a few days.
High Efficacy
Success rates exceeding 90% in symptom control in short and long term.
Lower Morbidity
Significant reduction in complications compared to traditional surgery.
Adaptability and Personalization
Effective for all achalasia subtypes. Myotomy length is adapted according to type (extended for type III).
Scientific Evidence for POEM
Recent studies published in the New England Journal of Medicine (2019) demonstrate that POEM is non-inferior to laparoscopic surgery in symptom control at 2 years, with the additional advantage of being less invasive. The ASGE 2020 guidelines recognize POEM as a first-line therapeutic option for achalasia.
Need a POEM treatment specialist?
As an expert trained in Japan with the creator of the technique, I offer cutting-edge POEM treatment at Hospital Universitario La Paz and INMEQ.
Book an AppointmentReal Patient Testimonials
Miguel G.
ACHALASIA surgery with POEM
"The truth is that the treatment was super personal, the sensation 24 hours later as if they hadn't operated on me. No nausea and I can swallow without problem, acceptance of all foods."
"Zero pain on the Madrid to Gran Canaria trip 20 hours later with no problem. Normal life 24/36 hours later, now at Las Canteras beach having a smoothie, the truth is that it's impressive..."
"THANK YOU doctor."
Return to normal life
Significant pain
Patient satisfaction
Post-Treatment Care with POEM
After POEM treatment, patients require specialized follow-up to optimize results and detect any situation requiring additional management:
Monitor treatment response
Continuous evaluation of symptom improvement using validated scales (Eckardt score)
Detect and manage gastroesophageal reflux
Prevention and treatment of reflux, which may appear after the procedure
Evaluate long-term esophageal function
Specialized functional follow-up with manometry and endoscopy as needed
Make necessary dietary adjustments
Personalized nutritional adaptation during recovery period
Typical post-POEM experience
- Progressive return to normal eating in 2-4 weeks
- Minimal postoperative pain or discomfort
- Absence of significant nausea
- Immediate resolution of dysphagia in most cases
Innovations and Future Perspectives
Ongoing research in the field of esophageal motility and endoscopic techniques promises new advances that will further improve treatment outcomes:
High-Resolution Mapping Techniques
Techniques such as EndoFLIP allow real-time monitoring of myotomy results during the procedure. This helps optimize the length of the muscle cut and minimize patients who don't fully respond after a first POEM session.
Technical Innovations
Introduction of water-immersion myotomy (water-jet dissection) to decrease thermal damage and post-procedure pain, as well as development of new endoclip devices for safer and more efficient closure.
Robot-Assisted POEM
Ongoing research on robotic systems that can assist in performing POEM, potentially improving precision and reducing variability between operators.
Experience and Specialized Training
With over 10 years of experience in advanced endoscopy and direct training with Prof. Haruhiro Inoue in Japan, creator of the POEM technique, I offer the highest level of expertise in treating esophageal achalasia.
Conclusion: A Promising Future for Achalasia Patients
Esophageal achalasia, although complex, is a treatable disease when approached with proper knowledge and techniques. POEM technique has transformed the therapeutic landscape, offering patients a less invasive and highly effective option.
As demonstrated by the testimonials of José Luis and Miguel González, the results speak for themselves: rapid recovery, minimal pain and immediate return to normal life.
My experience in advanced endoscopy and commitment to medical excellence allow me to offer my patients the most innovative treatment options available. Each case is unique and requires a personalized approach that considers both technical aspects and individual patient needs.
Final Message
If you have been diagnosed with esophageal achalasia or present suggestive symptoms, it is fundamental to seek specialized attention. With appropriate treatment, the vast majority of patients can return to enjoying normal eating and excellent quality of life.
Do you suffer from esophageal achalasia symptoms?
Get the specialized diagnosis and treatment you need. Like José Luis and Miguel González, you can recover your quality of life.
Hospital Universitario La Paz • INMEQ • Madrid
Scientific References
- 1. Werner YB, Hakanson B, Martinek J, et al. Endoscopic or Surgical Myotomy in Patients with Idiopathic Achalasia. The New England Journal of Medicine. 2019;381(23):2219-2229. doi:10.1056/NEJMoa1905380
- 2. Ma O, Brar K, McCluskey S, et al. Long-Term Outcomes After Per-Oral Endoscopic Myotomy Versus Laparoscopic Heller Myotomy in the Treatment of Achalasia: A Systematic Review and Meta-Analysis. Surgical Endoscopy. 2025. PMID: 40624423
- 3. Khashab MA, Vela MF, Thosani N, et al. ASGE Guideline on the Management of Achalasia. Gastrointestinal Endoscopy. 2020;91(2):213-227.e6. Full ASGE guideline access
- 4. de Moura ETH, Jukemura J, Ribeiro IB, et al. Peroral Endoscopic Myotomy vs Laparoscopic Myotomy and Partial Fundoplication for Esophageal Achalasia: A Single-Center Randomized Controlled Trial. World Journal of Gastroenterology. 2022;28(33):4875-4888. doi:10.3748/wjg.v28.i33.4875
- 5. Saleh CMG, Familiari P, Bastiaansen BAJ, et al. The Efficacy of Peroral Endoscopic Myotomy vs Pneumatic Dilation as Treatment for Patients With Achalasia Suffering From Persistent or Recurrent Symptoms After Laparoscopic Heller Myotomy: A Randomized Clinical Trial. Gastroenterology. 2023;165(2):367-377.e4. doi:10.1053/j.gastro.2023.03.211
Note: All references have been verified and correspond to scientific publications in high-impact medical journals. The links provide access to the original articles or their abstracts on PubMed.
