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Achalasia: What You Should Know

Medically Reviewed by Arefa Cassoobhoy, MD, MPH on July 01, 2020

What Is Achalasia?

Achalasia happens when the processes that move food to your stomach don’t work like they should. For food and liquids to pass from your mouth to your stomach, two things have to happen after you swallow. First, the esophagus, the tube that carries food to your stomach, has to move the food along by squeezing and relaxing. Once the food reaches the stomach, a small muscle flap or valve at the bottom of the esophagus must open to let the food empty into the stomach. 

If you have achalasia, neither of these processes works 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, like a clogged sink, and wash up back into your mouth.

Achalasia is rare. Approximately 1 in 100,000 people will get it. It can take years to develop, and some people ignore the symptoms for years before they go to a doctor.  Although the condition can’t be cured, treatment will help you live with it.

Achalasia Causes

Experts aren’t sure why achalasia happens. But possible causes are:
 

  • It’s passed down from your parents (genetics)
  • Autoimmune problems
  • A viral infection
  • A loss of nerve function (neurodegenerative)

Achalasia Risk Factors

People of all races can get achalasia. It’s found equally in men and women. It mainly happens in people 30 to 60 years old, although sometimes children have it. Achalasia is sometimes seen in people with Down syndrome.

Achalasia Symptoms

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

People with the condition may also have:

  • Chest pain, especially after eating
  • Food coming back up into the throat
  • Heartburn and belching
  • Weight loss
  • Nighttime coughing
  • Vomiting
  • Pneumonia from breathing food into the lungs

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

Achalasia Diagnosis

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

They 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.

Achalasia Treatment

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 they need 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, or POEM. 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 they see inside, they make a small cut to the internal lining of your esophagus. They tunnel through it to reach the inner muscle of the lower esophagus, where they make 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.

Other Treatments

You may not need surgery for achalasia. There are 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

Sources

SOURCES:

Pandolfino, J. JAMA, May 12, 2015.

Vaezi, M. American Journal of Gastroenterology, August 2013.

Mayo Clinic: “Achalasia: Definition.”

Genetic and Rare Diseases Information Center, National Institutes of Health: “Achalasia.”

The University of Chicago Medicine: “Achalasia.”

Memorial Sloan Kettering Cancer Center: “Diagnosis & Treatment of Achalasia.”

The Society of Thoracic Surgeons: “Achalasia and Esophageal Motility Disorders.”

Bhayani, N. Annals of Surgery, June 2014.

Washington University School of Medicine in St. Louis: “Heller Myotomy for Achalasia.”

American Cancer Society: “What Are the Risk Factors for Cancer of the Esophagus?”

The Society of Thoracic Surgeons: “Achalasia and Esophageal Motility Disorders.” 

Pandolfino, J. Journal of the American Medical Association, May 12, 2015. 

Genetic and Rare Diseases Information Center, National Institutes of Health.

Singapore Medical Journal: “Achalasia and Down syndrome: a unique association not to be missed.”

American Journal of Gastroenterology: “ACG Clinical Guideline: Diagnosis and Management of Achalasia.”

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