Achalasia: What You Should Know

Is it heartburn or achalasia? They have some things in common, but they’re not the same. While both can cause trouble swallowing and the feeling of food backing up into the throat, achalasia happens when the processes that move food to your stomach don’t work like they should.

Achalasia is rare. Approximately 1 in 100,000 people will get it. Although the condition can’t be cured, treatment will help you live with it.

What Is Happening?

Everyone has a muscle between the esophagus -- the tube that food passes through -- and the stomach. The muscle is supposed to open to let food and liquids pass into the stomach. Your esophagus also helps move food down into the stomach.

If you have achalasia, neither of these processes work well. The esophagus can’t push food down. Also, the valve doesn’t open up completely. This causes food to get caught at the base of the esophagus.

Achalasia doesn’t happen overnight. It can take years to develop, and some people ignore the symptoms for years before they go to a doctor.


Experts aren’t sure why achalasia happens. But genetics and immune system problems may be involved.


The biggest symptom of achalasia is trouble swallowing liquids and solid food.

People with the condition may also experience:

Eating within 4 hours of going to bed may make symptoms worse. Foods such as meat and bread may also cause trouble.


Because the symptoms of achalasia are so much like heartburn, your doctor may treat you for heartburn first. If that doesn’t work, he probably will test you for achalasia.

He may look down into your throat with a special tool called an endoscope. It has a tiny camera attached to a long tube so the doctor can see down your esophagus. 

The barium swallow test is a common screening test for achalasia. So is a test called manometry. A doctor runs a thin tube down your throat to test the strength of the esophagus muscles as you take sips of water. It also measures how well your stomach valve works.


Do I Need Surgery?

Surgery is the most successful achalasia treatment. With surgery, most people will get long-term relief from symptoms.

The most common procedure is called a Heller myotomy. Most of the time it’s done using a scope with a camera and a light, along with other instruments. The doctor makes several tiny cuts into the abdomen, and uses the surgical tools to reach the area he needs to work on. The goal of the operation is to open part of the lower esophagus to make swallowing easier. It’s usually very successful.

Another surgical option is called peroral endoscopic myotomy, orPOEM. With this procedure, doctors don’t have to cut outside the body. Instead, the doctor inserts an endoscope (a small tool with a camera on the end.) into the mouth and down the throat. Once he sees inside, he makes a small cut to the internal lining of your esophagus. He tunnels through it to reach the inner muscle of the lower esophagus, where he makes another cut. This helps make swallowing easier.

Both these surgeries are usually successful. But they can cause acid reflux in some people who have it done.

Your doctor will discuss which procedure might be best for you.

Treatment Without Surgery

You don’t necessarily need surgery for achalasia. There are a lot of other things that can help, but they usually don’t work as well. And you may need to go in for multiple procedures.

Some options are:

Injections of muscle-relaxing medicine. Your doctor injects Botox (botulinum toxin) into the tight esophagus muscles. This helps relax the muscles temporarily so you can swallow normally.

Stretching the esophagus (pneumatic dilation). The doctor inserts a balloon in the valve between the esophagus and stomach and blows it up to stretch the tight muscles. You might need this procedure several times before it helps.

Medication. Two classes of drugs, nitrates and calcium channel blockers, have LES muscle-relaxing effects. These drugs can decrease symptoms in people with achalasia.

Your doctor can also inject a type of drug into the esophagus that will help food go down better. But it only lasts for 6 months to a year.

The best treatment for you depends on many different things. Your doctor can help you decide what you need.


Living with Achalasia

There is no special diet for the condition, but you may discover on your own which foods pass through your esophagus more easily.

Drinking more water with meals may help. Sometimes carbonated drinks like colas help as well. The carbonation seems to help push the food through the esophagus.

If your achalasia is severe, a liquid diet may be your best bet for a while. Always talk to your doctor about getting the right nutrients if you’re not eating solid foods. If you lose a lot of weight, make sure to tell your doctor because it could mean you’re malnourished.

Some people with achalasia are at risk for cancer of the esophagus. For this reason, it’s very important to have regular visits with your doctor.

WebMD Medical Reference Reviewed by Nayana Ambardekar, MD on September 09, 2018



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