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Assoc. Prof. Cengiz Dibekoğlu, MD

General Surgeon · Laparoscopic · Robotic · Oncologic Surgery

Detailed chapter

Gastroesophageal Reflux (GERD) — Achalasia

Esophageal motility disorder and dysphagia

Achalasia is failure of the lower esophageal sphincter to relax with impaired esophageal peristalsis. Dysphagia, food stasis, and regurgitation mimic other diseases but heartburn is not typical. Diagnosis requires manometry; treatment includes pneumatic dilation, POEM, or Heller myotomy.

Achalasia · educational illustration

Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

© Cengiz Dibekoğlu — illustrative; not for unauthorized use

Figure summary

  • This educational figure shows: Achalasia.
  • Related figures on this page: Pneumatic dilation, POEM, Heller myotomy.

Related educational figures

Tap a figure to enlarge.

  • Pneumatic dilation

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

    Figure summary

    Pneumatic dilation

  • POEM

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

    Figure summary

    POEM

  • Heller myotomy

    Educational schematic. Some structures may be simplified or emphasized for clarity; not an exact anatomical depiction.

    © Cengiz Dibekoğlu — illustrative; not for unauthorized use

    Figure summary

    Heller myotomy

Key points

  • Symptoms

    In achalasia, dysphagia to both solids and liquids is typical; regurgitation, food stasis, chest discomfort, and weight loss may accompany it.

  • Diagnosis

    Key note inside

    Endoscopy excludes alternate causes; barium swallow may show bird-beak narrowing. Unexplained dysphagia should not be labeled reflux alone — mechanical obstruction and motility disorders must be excluded. High-resolution manometry is the key test to confirm achalasia.

    • Manometry: high LES pressure that fails to relax with swallows
    • Manometry: absent progressive peristalsis in the esophageal body
    • Barium: bird-beak taper may support the diagnosis

  • Treatment

    Pneumatic dilation, POEM, or Heller myotomy are selected by anatomy, experience, and patient factors. Partial fundoplication after Heller may reduce reflux risk. The figures below summarize the three approaches side by side.

  • How is Heller myotomy performed?

    Heller myotomy divides the muscle of the lower esophageal sphincter from the outside while preserving intact mucosa, to ease swallowing. The same principle can be done laparoscopically, open, or robotically. Choice depends on anatomy, prior operations, comorbidities, and team experience. Most suitable candidates today are treated with minimally invasive laparoscopic or robotic approaches; open surgery remains an option in selected complex or redo settings. The goal is to cut muscle and leave the mucosa intact — laparoscopic, open, and robotic routes share that aim.

    • Laparoscopic Heller: common minimally invasive route with camera and long instruments
    • Open Heller: larger incision; still used in selected complex cases
    • Robotic Heller: wristed instruments, 3D vision, and tremor filtration may aid precise myotomy and hiatal dissection
    • Robotic advantages are possible—not a guaranteed better outcome for every patient; experience and case factors decide

  • Follow-up

    Key note inside

    Follow-up is individualized to symptoms and treatment response; routine endoscopic surveillance for cancer screening alone is not standard. Long-standing food stasis carries megaesophagus risk.

Frequently asked questions

  • Is achalasia the same as reflux?

    No. PPIs do not treat achalasia; manometry distinguishes the two.

  • Can Heller myotomy be done robotically?

    Yes. Heller can be laparoscopic, open, or robotic. Robotics may help with fine dissection and 3D visualization in experienced centers, but it is not automatically superior for every patient.

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Evidence

Scientific sources

Show sources · 2

ACG / ASGE upper-GI motility guidance for achalasia diagnosis (manometry) and treatment. It must not be confused with GERD.

  1. 1. ACG clinical guidelines — GI disease and colorectal cancer screeningAmerican College of Gastroenterology (ACG) · Living guidelinesOpen source →
  2. 2. ASGE guideline library — endoscopy, polypectomy, and achalasiaAmerican Society for Gastrointestinal Endoscopy (ASGE) · Guideline libraryOpen source →

Last reviewed: 21 August 2026. Links go to publisher pages.

This page is for education. It is not medical advice and does not replace a visit with your physician.

Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.

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