17534 Achalasia

Overview

Achalasia is a rare condition that affects your esophagus (the tube that carries food from your mouth to your stomach). The nerves in the esophagus become damaged, so the muscles don't squeeze food down properly and the valve at the bottom of the esophagus doesn't relax to let food through. This makes swallowing difficult and can cause food and saliva to collect in your throat.

Achalasia is rare. It affects about 1 in every 100,000 people each year.

It can happen at any age, but it is most often diagnosed in adults between the ages of 25 and 60. Men and women are affected equally.

Symptoms

Common symptoms

• Trouble swallowing food and liquids (dysphagia)
• Chest pain or discomfort, especially after eating
• Regurgitation of food or saliva (food coming back up)
• Heartburn or a burning feeling in the chest
• Coughing or choking at night
• Unintentional weight loss

Causes

Main causes

• Damage to the nerves in the wall of the esophagus, which affects muscle movement
• The lower esophageal sphincter (the muscle at the bottom of the esophagus) fails to relax properly
• The exact reason for this nerve damage is not fully understood

Risk factors

• Having an autoimmune disease, such as lupus or Sjögren's syndrome
• A family history of achalasia (although this is uncommon)
• A viral infection may trigger the body's immune response, but this is still being studied

When to see a doctor

See a doctor urgently if:

• Call your local emergency number right away if you have sudden severe chest pain or difficulty breathing.
• If you are unable to swallow anything, including your own saliva, go to an emergency department.

Book a routine appointment if:

• Make an appointment with your doctor if you have trouble swallowing that lasts more than a few weeks.
• Tell your doctor if you are losing weight without meaning to, or if you frequently spit up food.

Diagnosis

Your doctor will first take a detailed history and ask about your symptoms. If they suspect achalasia, they will refer you to a gastroenterologist (a doctor who specialises in the digestive system) for tests.

Tests that may be done

• Barium swallow – you drink a chalky liquid that coats your esophagus, and X-rays show how it moves
• Endoscopy – a thin, flexible tube with a camera is passed into your esophagus to look at it directly
• Esophageal manometry – a small tube measures the pressure and squeezing in your esophagus. This test can confirm achalasia

What to expect at your appointment

These tests are usually done as outpatient procedures, meaning you do not need to stay in hospital. You may be asked not to eat or drink for a few hours before some tests. The results will help your doctor plan the best treatment for you.

Treatment

There is no cure for achalasia, but several treatments can reduce symptoms and help you eat more comfortably. The right treatment depends on your age, overall health, and how severe your symptoms are. A specialist will discuss the options with you.

Self-care at home

• Eat smaller, more frequent meals
• Chew your food thoroughly and eat slowly
• Take small sips of water with meals to help food pass through
• Stay sitting upright for at least 30 minutes after eating
• Avoid foods that are very hot, very cold, or likely to get stuck, like tough meats or dry bread
• Keep your head raised with extra pillows when sleeping to reduce regurgitation at night

Medical treatments

Your doctor may talk to you about medications that help relax the muscle at the bottom of the esophagus. These can work for a short time, but they are not a permanent solution. Another common treatment is pneumatic dilation, where a balloon is inflated inside the esophagus to stretch the valve area. Muscle-relaxing injections are also used to reduce the tightness, though the effect wears off over time and repeat treatments may be needed.

When is surgery considered?

Surgery may be recommended if other treatments do not help or if you are a good candidate. A procedure called Heller myotomy cuts the tight muscle at the bottom of the esophagus. Another procedure, called POEM (peroral endoscopic myotomy), is done through an endoscope and can also be effective. Your specialist will explain what these procedures involve.

Living with this condition

Living with achalasia means paying a bit more attention to how you eat. Many people adapt by planning meals, choosing soft foods, and making sure they have plenty of time to eat without rushing. Staying upright after meals and sleeping with your head raised can help prevent symptoms.

Lifestyle tips

• Eat in a relaxed, upright position and avoid lying down right after meals
• Drink water throughout meals to help food move down
• Keep a food diary to spot foods that trigger your symptoms
• Maintain a healthy weight; if you are losing weight unintentionally, talk to your doctor
• Avoid smoking and limit alcohol, as these can irritate the esophagus

Diet and exercise

There is no one-size-fits-all diet for achalasia, but most people do well with soft, moist foods that are easy to swallow. Cutting your food into small pieces and chewing well is important. Exercise is generally fine and can support your overall wellbeing, but heavy exercise right after meals may make symptoms worse.

Mental health and emotional wellbeing

Achalasia can affect your quality of life and may make social eating feel stressful. It is normal to feel anxious, embarrassed, or down about eating difficulties. Talk to your doctor if you are struggling emotionally, and remember that seeking support is a sign of strength.

Prevention

There is no known way to prevent achalasia because the exact cause is not understood. Research is ongoing, but currently it is not linked to any specific lifestyle choice.

Complications

If left untreated

• Food can become trapped in the esophagus (food impaction), which can be painful and require emergency treatment
• Aspiration pneumonia – breathing food or saliva into the lungs, leading to chest infection
• Severe weight loss and malnutrition because you are not getting enough nutrients
• The esophagus may become stretched and floppy over time, making future treatment harder
• Slightly increased risk of esophageal cancer after many years

Long-term outlook

With proper treatment, most people with achalasia get significant relief from their symptoms and can enjoy a near-normal diet. It may take time to find the best treatment for you, but the outlook is generally good. Regular check-ups with your specialist will help monitor your condition and manage any changes.

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