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Overview
What Is Achalasia?
Achalasia is a rare swallowing disorder in which the esophagus has trouble moving food down into the stomach. The lower esophageal sphincter, a muscle at the bottom of the esophagus, does not relax normally when you swallow. This can cause food and liquid to collect in the esophagus. Achalasia can affect adults of different ages, although it is uncommon.
Symptoms
Achalasia Symptoms
Common achalasia symptoms include difficulty swallowing both solid foods and liquids. People may bring up undigested food or saliva, sometimes hours after eating, and may feel chest discomfort or pressure. Symptoms often worsen gradually, which can make eating, sleeping and daily activities more difficult.
- Nighttime coughing or choking may occur when retained food or saliva comes back up while lying down.
- Heartburn-like discomfort can develop and may be mistaken for acid reflux.
- Unintended weight loss may occur when swallowing becomes difficult or eating is avoided.
- Some people have difficulty eating enough to maintain adequate nutrition and energy.
Causes
What Causes Achalasia?
Achalasia results from impaired nerve signaling and muscle coordination in the esophagus. This reduces the wave-like contractions, called peristalsis, that move food downward and prevents the lower esophageal sphincter from relaxing fully. The exact event that starts this nerve damage is often unknown. Achalasia cardiospasm is another name sometimes used for this condition.
Risk Factors
Achalasia Risk Factors
Achalasia can occur in people of any sex or age, and there is no reliably preventable cause. Most cases are not linked to a lifestyle choice or a clearly identifiable risk factor. The factors below describe patterns clinicians may consider rather than causes that can predict who will develop achalasia.
- Achalasia is most often diagnosed in adults, although it can occur at other ages.
- Uncommon familial cases suggest that family history may play a role for a small number of people.
- Rare disorders can produce secondary achalasia-like obstruction or swallowing problems that resemble achalasia.
- A clinician may investigate an underlying condition when symptoms or test findings do not fit typical achalasia.
Complications
Achalasia Complications
- Ongoing difficulty swallowing can lead to weight loss and malnutrition.
- Reduced fluid intake or repeated regurgitation can cause dehydration.
- Food or liquid entering the airways can cause a persistent cough or aspiration pneumonia.
- Long-standing food retention can cause the esophagus to widen.
- Persistent symptoms can reduce quality of life and make eating or social activities stressful.
Complications are more likely when swallowing problems continue without effective treatment. Treatment for esophageal achalasia can improve emptying, reduce symptoms and lower related risks, although ongoing follow-up may still be needed.
SEEK PROMPT CARE
When complications may be developing
Seek prompt medical evaluation if you cannot keep fluids down, develop breathing problems after regurgitation, show signs of dehydration or experience rapidly worsening swallowing difficulty.
Diagnosis
How Is Achalasia Diagnosed?
Diagnosis begins with a detailed swallowing history and physical examination. Clinicians then use tests to distinguish achalasia from acid reflux, a structural blockage and other esophageal motility disorders. The results also help guide the most suitable treatment.
- Upper endoscopy uses a flexible camera to examine the esophagus and stomach and help rule out blockage, inflammation or other conditions.
- A timed barium esophagram or barium swallow uses X-rays to show how quickly contrast moves through the esophagus and whether it collects above a narrowed sphincter.
- High-resolution esophageal manometry measures pressure, muscle contractions and lower esophageal sphincter relaxation during swallowing.
Treatment & Management
Achalasia Treatment and Management
Achalasia treatment aims to improve emptying of the esophagus by reducing resistance at the lower esophageal sphincter. Available treatments can relieve swallowing symptoms, but they do not restore the damaged nerve function itself. The best option depends on symptom severity, test results, overall health, reflux risk and specialist experience.
| Treatment | How it helps | Typical role | Key considerations |
|---|---|---|---|
| Pneumatic dilation | A balloon is inflated to stretch and loosen the lower esophageal sphincter. | A commonly used treatment that may provide lasting symptom relief. | Symptoms can return, and there is a small risk of a tear requiring urgent treatment. |
| Laparoscopic Heller myotomy | Surgery cuts selected sphincter muscle fibers to improve passage into the stomach. | A durable option for many people, often combined with an anti-reflux procedure. | It requires surgery and may increase the need to monitor or treat reflux. |
| Peroral endoscopic myotomy | An endoscope creates a tunnel in the esophageal wall so the sphincter muscle can be divided. | A minimally invasive procedure used in suitable patients, including some with complex disease. | Reflux can occur afterward, and results depend on the procedure and specialist expertise. |
| Botulinum toxin injection | The injection temporarily relaxes the lower esophageal sphincter. | May be considered for people who cannot safely undergo more durable procedures. | Relief is usually temporary, and repeat injections may make later treatment more difficult. |
| Medicines | Certain medicines can temporarily lower sphincter pressure or relax the muscle. | Sometimes used when procedures are unsuitable or while planning further care. | They are generally less effective and may cause side effects or short-lived relief. |
Life after treatment and long-term monitoring
Outlook and Prognosis
Outlook and Prognosis for Achalasia
Achalasia is generally manageable rather than curable because treatment does not repair the underlying nerve damage. Many people improve substantially after treatment, but symptoms can recur or change over time. Regular follow-up helps identify returning swallowing problems, reflux or nutritional concerns early.
- Attend follow-up visits even when swallowing has improved.
- Report returning difficulty swallowing, regurgitation or chest discomfort to your care team.
- Monitor for reflux symptoms and nutritional concerns after treatment.
- Seek support if eating, travel or social activities become difficult because of symptoms.
When Should You See a Doctor
When Should You See a Doctor for Achalasia Symptoms?
Arrange a medical evaluation for recurring difficulty swallowing, regurgitation, unexplained weight loss or chest discomfort with eating. Symptoms that progressively worsen should not be dismissed as ordinary reflux. Early assessment can help identify achalasia and other causes of swallowing problems.
GET URGENT HELP
Symptoms that should not wait
Seek urgent care if you cannot swallow liquids or saliva, have choking or breathing difficulty after regurgitation, develop severe dehydration, vomit blood, pass black stools or experience sudden severe chest pain.
Symptoms
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Achalasia
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