Achalasia: Symptoms, Causes & Treatment

Achalasia is a rare disorder affecting the motility of the esophagus (the tube that carries food from the throat to the stomach). Normally, the esophageal muscles move in a coordinated way to push food, and the lower esophageal sphincter relaxes to allow food to pass into the stomach. In achalasia, the nerve cells regulating this movement are damaged, so the lower muscle fails to relax and esophageal motility weakens.

As a result, food and liquids accumulate in the esophagus above the spasmed muscle instead of passing smoothly, and symptoms appear gradually, most importantly difficulty swallowing (dysphagia) of both solid and liquid food, regurgitation of undigested food, chest pain or discomfort, weight loss over time, and there may be coughing or nighttime choking when food regurgitates into the throat.

Achalasia is a chronic condition that does not heal on its own but is effectively manageable to ease symptoms and facilitate swallowing. Diagnosis relies on esophageal endoscopy, an esophageal motility study (manometry) that confirms the diagnosis, and a characteristic barium swallow image. Achalasia is not radically treated with medication but with procedures targeting the lower esophageal sphincter, such as balloon dilation or cutting it surgically or by per-oral endoscopy, to ease food passage. Early detection is important to avoid complications and maintain nutrition, so any progressive swallowing difficulty deserves specialist evaluation.

• Progressive difficulty swallowing solids and liquids.
• Regurgitation of undigested food.
• Chest pain or discomfort.
• Weight loss over time.
• Coughing or nighttime choking.

• Damage to the nerve cells regulating esophageal movement.
• The exact cause is uncertain; immune, genetic, and viral factors may be involved.
• Failure of the lower esophageal sphincter to relax.

• Esophageal endoscopy to rule out other causes.
• An esophageal motility study (manometry) to confirm the diagnosis.
• A characteristic barium swallow image.

Procedures targeting the sphincter

• Balloon dilation of the muscle via endoscopy.
• Surgical muscle cutting (Heller myotomy) or per-oral endoscopic myotomy (POEM).

Other options

• Injecting a substance to relax the muscle in selected cases not eligible for surgery.
• Supportive dietary modifications (chewing well, soft food, drinking water with meals).

This content is educational and does not replace consulting a gastroenterologist.

• Malnutrition and weight loss.
• Esophagitis and aspiration of food into the lung (pneumonia).
• A slight long-term increase in esophageal cancer risk warranting follow-up.

• There is no known prevention, but early detection prevents complications.
• Regular follow-up after treatment.
• Supportive dietary modifications to ease swallowing.