What Is Achalasia?

Your esophagus is the long, hollow tube connecting your throat and stomach. When you eat or drink, your esophagus transfers the food or drink from your mouth to your stomach.

If the muscles in your esophagus don’t work right, it affects the ability for food and drinks to reach your stomach. These types of conditions are called esophageal motility disorders.

One type of rare esophageal motility disorder is achalasia.

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What Is Achalasia?

Achalasia is a rare disease of the esophagus. It happens when the lower esophageal sphincter (LES), a muscular ring at the bottom of your esophagus, does not work right.

In normal conditions, the LES relaxes when you swallow food or drink. This allows the food or drink to pass through to your stomach.

In people with achalasia, the LES does not relax. Achalasia also affects your esophagus’ ability to push food down to your stomach through contractions, a process called peristalsis.

As a result, achalasia affects your ability to swallow and disrupts the normal digestive process. About 1 in every 100,000 people in the United States has achalasia, with about 3,000 new cases diagnosed each year.

The exact cause of achalasia is unknown. Some potential causes include a virus, autoimmune disorder, or genetics. There are no specific risk factors, and the condition can develop at any age. Most people are diagnosed between the ages of 25 and 60.

Achalasia Symptoms

The symptoms of achalasia can appear gradually. They often appear similar to other esophagus disorders like gastroesophageal reflux disease (GERD).

The most common symptom is dysphagia, or difficulty swallowing due to “food sticking” or feeling like it is not passing into the stomach. Other symptoms include:

  • Difficulty swallowing food or drink.
  • Backflow or regurgitation of food or drink.
  • Chest pain.
  • Cough.
  • Heartburn.
  • Weight loss.
  • Dry eyes.
  • Dry mouth.

How Is Achalasia Diagnosed?

Achalasia can be difficult to diagnose early — sometimes taking years. This can cause problems because achalasia can put you at increased risk for other medical conditions, including esophageal cancer.

Inability to swallow food or drink may cause you to aspirate them into your lungs. This puts you at risk for respiratory infections like pneumonia.

Doctors can’t diagnose achalasia through symptoms alone. Tests that can help diagnose the condition include:

  • Barium swallow and x-ray. You swallow a liquid containing barium. This makes it easier for doctors to view the inside of your esophagus during an x-ray. Doctors may take several x-rays after the barium swallow to test how well your esophagus is working. X-rays may show dilation or other changes in your esophagus’ appearance. This can help diagnose achalasia.
  • Upper endoscopy. Doctors insert an endoscope (a long, flexible tube attached to a camera) into your mouth and through your esophagus. They can view the camera’s images on a TV screen during the procedure. This test can provide more accurate images than an x-ray. It also can check to see whether your esophagus has any obstructions.
  • Manometry. In this test, doctors insert a catheter through your nose and esophagus and into your stomach. It can reveal whether your lower esophageal sphincter isn’t relaxing right and if there is a problem with peristalsis.

Treatment for Achalasia

There is no cure for achalasia. But treatment can help relieve symptoms and prevent other health complications.

  • Medications. Some drugs can help your lower esophageal sphincter relax. This may help improve its function. Although medication may provide relief, it may not be a long-term solution.
  • Botox injections. Injections of Botox can relax the muscles of the lower esophageal sphincter. But this also is often a temporary solution and can become less effective over time.
  • Dilation of the esophagus. Dilation is a procedure where doctors will stretch the muscles of your lower esophageal sphincter. Although you may need repeated procedures, this often is the best treatment option for people who aren’t candidates for surgery.
  • Surgery. At UPMC, our experts offer open and minimally invasive surgical techniques, including robot-assisted surgery. A procedure called a myotomy can cut the affected muscles of your lower esophageal sphincter, allowing it to relax. There are two options: a robotic-assisted laparoscopic Heller myotomy or a peroral endoscopic myotomy. Some people may develop gastroesophageal reflux after surgery. To reduce your risk, doctors may also perform an anti-reflux procedure. For rare or more advanced cases, minimally invasive esophagectomy (MIE) is an option.

Although there is no cure for achalasia, it is important to get treatment. It can provide relief and help lower your risk of other complications.

If you are experiencing symptoms of achalasia, it’s important to seek care as soon as you can. At UPMC, our gastroenterology experts provide care for a wide range of disorders involving the gastrointestinal (GI) tract. To find a GI doctor near you, visit our website.

Ines Gockel, Prof. Dr. Med, Michaela Müller, Dr. Med., Johannes Schumacher, PD Dr. Med., Deutsches Ärzteblatt International, Achalasia—a Disease of Unknown Cause That Is Often Diagnosed Too Late. Link

Ifeanyi I. Momodu and Jason M. Wallen, StatPearls, Achalasia. Link

National Library of Medicine, Achalasia. Link

National Library of Medicine, Esophagus Disorders. Link

National Organization of Rare Diseases, Achalasia. Link

The Society of Thoracic Surgeons, The Patient Guide to Heart, Lung, and Esophageal Surgery, Achalasia and Esophageal Motility Disorders. Link

The Society of Thoracic Surgeons, The Patient Guide to Heart, Lung, and Esophageal Surgery, Common Diagnostic Tests. Link

About Digestive Disorders

UPMC Digestive Health Care cares for a wide range of gastrointestinal (GI) conditions and diseases, from diagnosis to treatment. Whether your digestive condition is common or complicated, our experts can help. Upon referral from your physician, we coordinate your testing and treatment. If you have a complicated condition, we can refer you to one of UPMC’s digestive health centers of excellence. Find a GI doctor near you.