What is achalasia?
Achalasia is a swallowing disorder that affects the esophagus. This is the tube that
connects the back of your throat to your stomach. Food and liquid go down the tube
when you swallow. If you have achalasia, the muscles of the esophagus don’t work well
at pushing food or liquid down into your stomach. The valve at the lower end of your
esophagus (lower esophageal sphincter, or LES) also has a problem. The ring of muscle
in the valve does not relax enough to let food and liquid pass easily from the esophagus
into the stomach. Achalasia means “failure to relax.”
Achalasia often develops slowly. It becomes harder to swallow food and drinks over
time. Achalasia has no cure. But symptoms can be controlled with treatment.
What causes achalasia?
In most cases it's caused by loss of the nerve cells that control the swallowing muscles
in the esophagus. Healthcare providers don’t yet know why these nerve cells are lost.
In rare cases, achalasia is caused by a tumor.
Who is at risk for achalasia?
Achalasia can occur at any age. But it happens most often between ages 30 and 60.
Men and women are equally at risk. Healthcare providers don’t know why achalasia happens.
But risk factors may include:
Genes you are born with
A problem with your immune system that causes it to attack nerve cells in your esophagus
Having herpes simplex virus or other viral infections
Having Chagas disease. This is an infection caused by a parasite. The parasite is
passed to people through the bite of an insect. Chagas disease is mainly found in
poor rural areas of Mexico and Central and South America.
What are the symptoms of achalasia?
Symptoms can occur a bit differently in each person. They develop over time as the
esophagus becomes wider and weaker. Symptoms can include:
Trouble swallowing food (dysphagia)
Food or liquid flowing back up into your throat (regurgitation)
Waking up at night coughing or choking due to regurgitation
Chest pain or pressure
The symptoms of achalasia may be like other health conditions. Always see your healthcare
provider for a diagnosis.
How is achalasia diagnosed?
Your healthcare provider will ask about your symptoms and health history. He or she
will give you a physical exam. You may also have tests, such as:
Endoscopy. A flexible lighted tube is passed through your mouth to look at your esophagus and
the lower esophageal sphincter (LES).
Esophogram. This is a type of X-ray that takes pictures of your esophagus while you swallow a
thick contrast material called barium. You may swallow a barium tablet as well. The
radiologist looks for signs of achalasia. These include widening of the esophagus,
incomplete emptying, and tightness of your LES.
Manometry. A thin tube that measures pressure is passed through your nose down into your esophagus.
Pressure measurements are taken as you swallow sips of water. This test can show if
the muscles in your esophagus are weak and don’t work well. The test can also show
pressure buildup at your LES. This test confirms a diagnosis of achalasia.
How is achalasia treated?
There's no cure for achalasia. But treatments can manage your symptoms. Treatments
You may also need repeat treatments. Treatment may include the following.
This is an outpatient procedure done under anesthesia. Your healthcare provider looks
into your esophagus through an endoscope. He or she passes a small balloon through
the LES. The balloon is then inflated using an X-ray to guide it. You may need more
than 1 treatment to get relief.
Botulinum toxin injection
Botulinum toxin is a medicine that can paralyze muscles. It can be injected into the
muscles that control your LES. This helps to relax the valve opening. This procedure
is done during endoscopy. You may be asleep or partly asleep with sedation through
an IV (intravenous line). The benefits often go away in 3 to 12 months. So the procedure
needs to be repeated.
Surgery may be done to open your LES. This is called myotomy. During myotomy, the
muscles of the LES are cut. This procedure can be done using a minimally-invasive
approach called laparoscopy. A few small cuts (incisions) are made. A thin, lighted
tube called a laparoscope is used. This scope lets the doctor see inside your body
and work through the small incisions. At the same time, your surgeon may do a procedure
called a fundoplication to help minimize acid reflux (GERD) after the procedure. This
is done by wrapping the very top of the stomach around the lower part of the esophagus.
This type of surgery often gives long-term relief from achalasia symptoms.
Peroral endoscopic myotomy (POEM)
Your healthcare provider inserts an endoscope through your mouth and down your esophagus.
An incision is made in the inner lining of the esophagus. The endoscope then enters
between the layers of the esophagus to the muscle. Part of the muscle layer is removed
in the lower part of the esophagus, the LES, and the upper part of the stomach. This
decreases the tightness from the LES. It allows food and liquid to pass from the esophagus
into the stomach more easily. This procedure is available at certain healthcare centers.
It is not an option for everyone. POEM is considered less invasive and recovery is
rapid. But it results in frequent acid reflux and you most likely will need treatment
for GERD after the procedure.
There are 2 medicines often used to treat achalasia. They are calcium channel blockers
and long-acting nitrates. These medicines are used if surgery is not a choice or if
your symptoms continue even with Botox.
Talk with your healthcare providers about the risks, benefits, and possible side effects
of all treatments.
What are possible complications of achalasia?
Treatment can help prevent long-term complications such as:
Aspiration pneumonia. This is caused when food or liquids in your esophagus back up into your throat and
you breathe them into your lungs.
Esophageal perforation. This is a hole in the esophagus. It may happen if the walls of your esophagus become
weak and bulge. It may also happen during treatment. Esophageal perforation may cause
a life-threatening infection.
Esophageal cancer. People with achalasia are at higher risk for this type of cancer.
Can achalasia be prevented?
Researchers don’t know how to prevent achalasia.
Living with achalasia
Achalasia is a chronic condition. But you can manage it by working with your healthcare
provider to create a treatment plan. Your healthcare team will need to see you 1 or
2 times a year, even after your symptoms have lessened. You may need repeat endoscopy
and esophogram procedures.
If you have symptoms of dysphagia or regurgitation:
Don’t eat foods or have drinks that give you heartburn.
Drink plenty of fluids when eating. Chew your food well.
Eat smaller meals more often.
Don’t overeat late at night.
If you have symptoms at night, prop up the head of your bed.
When should I call my healthcare provider?
Call your healthcare provider if you have any questions about your medicines or treatment.
Tell your healthcare provider right away if you have any of these:
Trouble swallowing that gets worse
Regurgitation that gets worse
Waking up coughing or choking at night
Symptoms of infection such as chills or fever
Chest pain or trouble breathing
Key points about achalasia
Achalasia is a swallowing disorder that affects the esophagus. The muscles of the
esophagus don’t work well at pushing food or liquid into your stomach.
Achalasia usually develops slowly. It becomes harder to swallow food and drinks over
Symptoms can include trouble swallowing food, and food or liquid flowing back up into
You may have tests, such as an endoscopy or esophogram.
There is no cure. But treatments can manage your symptoms. Treatment may include pneumatic
dilation, botulinum toxin injections, surgery, or medicines.
Tips to help you get the most from a visit to your healthcare provider:
Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells
At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also
know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that
Know how you can contact your provider if you have questions.