Achalasia awareness

Overview

Achalasia is a rare condition where the tube that carries food from your mouth to your stomach (the esophagus) stops working properly. The muscle at the bottom of the esophagus (the lower esophageal sphincter) does not relax to let food pass into the stomach, and the esophagus also loses its ability to push food down. This can make swallowing difficult.

No, achalasia is uncommon. It is considered a rare disease.

Achalasia can affect people of any age, but it is most often diagnosed in adults between 25 and 60 years old. It affects men and women equally.

Symptoms

Common symptoms

• Difficulty swallowing (dysphagia) – feeling like food is stuck in the chest or throat.
• Regurgitation of undigested food – food comes back up, especially when lying down or bending over.
• Chest pain that can be mistaken for a heart attack – often happens after eating.
• Heartburn that does not respond to usual treatments.
• Unexplained weight loss.
• Coughing or choking, especially at night.

Symptoms in children

• In children, symptoms can include poor feeding, vomiting, and slow weight gain.
• Children may cough or choke during meals.
• Older children may complain of food sticking in the chest.

Symptoms in older adults

• In older adults, symptoms may be mistaken for age-related changes or other conditions like GERD.
• Chest pain and difficulty swallowing are common, but may be less noticeable.
• Weight loss and malnutrition can occur without obvious symptoms.

Causes

Main causes

• The exact cause of achalasia is unknown. It is thought to be an autoimmune disorder where the body’s immune system attacks the nerves in the esophagus.
• Damage to the nerves that control the muscles of the esophagus leads to the lower esophageal sphincter not relaxing and the esophagus losing its ability to push food down.

Risk factors

• There is a possible link to certain viral infections, but this is not proven.
• Achalasia can run in families, but most cases are not inherited.
• No specific lifestyle factors are known to increase risk.

When to see a doctor

See a doctor urgently if:

• If you have severe chest pain or difficulty breathing, seek emergency care.
• If you cannot swallow liquids or have choking episodes, see a doctor urgently.

Book a routine appointment if:

• If you have ongoing difficulty swallowing, heartburn, or food coming back up, make an appointment with your healthcare provider.
• Unexplained weight loss or coughing after eating also warrants a check-up.

Diagnosis

Diagnosis is made based on your symptoms, a physical exam, and specific tests to see how your esophagus works.

Tests that may be done

• Barium swallow – you drink a chalky liquid, and X-rays show how it moves through your esophagus.
• Esophageal manometry – a thin tube is passed through your nose into your esophagus to measure muscle contractions and pressure.
• Upper endoscopy – a thin, flexible tube with a camera is used to look inside your esophagus and stomach to rule out other conditions.

What to expect at your appointment

You may be referred to a gastroenterologist (a doctor specializing in digestive disorders) for these tests. The procedures are usually done as an outpatient and are not painful, though some may cause temporary discomfort.

Treatment

Treatment aims to relax the lower esophageal sphincter so food can pass into the stomach. Options include medications, procedures, and surgery. There is no cure, but most people get good relief from symptoms.

Self-care at home

• Eat slowly and chew food thoroughly.
• Drink plenty of fluids with meals to help food go down.
• Avoid eating too close to bedtime – wait at least 3 hours after eating before lying down.
• Sleep with your head elevated to reduce regurgitation at night.

Medical treatments

Doctors may recommend medications that relax the lower esophageal sphincter (such as calcium channel blockers or nitrates), but these are not as effective as procedures and can have side effects. Pneumatic dilation is a procedure where a balloon is inflated in the lower esophagus to stretch the sphincter. Botulinum toxin (Botox) injections can be given via endoscopy to temporarily relax the muscle.

When is surgery considered?

Surgery called laparoscopic Heller myotomy is often the most effective treatment. It involves cutting the muscle at the lower esophagus to allow food to pass. This is usually done as a keyhole (laparoscopic) operation.

Living with this condition

Managing achalasia involves adapting your eating habits and following your treatment plan. Many people live well with the condition after treatment, but it requires ongoing attention.

Lifestyle tips

• Eat smaller, more frequent meals.
• Avoid foods that are hard to swallow, like dry bread or tough meat.
• Maintain a healthy weight – if you have weight loss, talk to a dietitian.
• Stay upright for at least 30 minutes after eating.

Diet and exercise

A soft or liquid diet may help during flares. Cut food into small pieces. Chew well. Avoid carbonated drinks and alcohol. Gentle exercise is fine, but avoid heavy lifting or anything that increases pressure in the abdomen right after meals.

Mental health and emotional wellbeing

Living with a chronic swallowing problem can be stressful and may lead to anxiety, especially around eating in public. It is normal to feel frustrated or worried. Talk to your doctor if you feel overwhelmed – they can refer you to a counselor or support group.

Prevention

At this time, there is no known way to prevent achalasia because the cause is not well understood.

Complications

If left untreated

• Untreated achalasia can lead to severe weight loss and malnutrition.
• Food and liquids may be breathed into the lungs, causing pneumonia (aspiration pneumonia).
• The esophagus can become stretched and widened (megaeosphagus), making treatment more difficult.
• There is a small increased risk of esophageal cancer over time.

Long-term outlook

With proper treatment, the outlook for achalasia is good. Most people experience significant improvement in swallowing and quality of life. While the condition is not curable, symptoms can usually be managed effectively for many years. Regular follow-up with your doctor is important to monitor for any complications.

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