What is Achalasia?

Achalasia is a condition that affects the esophagus, the tube that carries food and drinks from your mouth to your stomach. In people with achalasia, the muscles in the esophagus do not move food normally, and the valve at the bottom of the esophagus does not relax the way it should.

Because food and liquids cannot pass easily into the stomach, swallowing becomes more difficult over time. Symptoms often develop slowly and may gradually worsen if the condition is not treated.

Experts do not fully understand what causes achalasia. It is believed to happen when nerves in the esophagus become damaged, preventing the muscles from working correctly. In rare cases, infections or other medical conditions may play a role.

Symptoms

Achalasia can affect people differently, but symptoms usually become more noticeable over time. Common symptoms include:

• Trouble swallowing food or liquids
• Food or drinks coming back up after eating
• Chest discomfort or pressure
• Heartburn or a burning feeling in the chest
• Coughing or choking at night
• Feeling like food is stuck in the throat or chest
• Unexplained weight loss

How is it diagnosed?

Your healthcare provider will ask about your symptoms and perform an exam. Several tests may be used to confirm achalasia and rule out other digestive conditions.

Common diagnostic tests include:

• Upper endoscopy to look inside the esophagus and stomach
• Barium swallow imaging to evaluate how food moves through the esophagus
• Esophageal manometry to measure muscle function and pressure inside the esophagus

These tests help determine how well the esophagus is working and guide treatment planning.

How is it treated?

Although achalasia cannot currently be cured, treatment can help improve swallowing and reduce symptoms. Providers usually begin with the least invasive options before considering surgery.

Treatment options may include:

• Balloon dilation to gently stretch the tight lower esophageal valve
• Botulinum toxin (Botox) injections to relax the muscles temporarily
• Medications to help relax the esophagus in some patients
• Minimally invasive surgery, such as myotomy, to reduce tightness in the lower esophagus
• POEM (Peroral Endoscopic Myotomy), an endoscopic procedure used in certain cases

Many people experience significant symptom relief after treatment. Some patients may need repeat procedures or long-term follow-up care. Because acid reflux can occur after treatment, additional medication or lifestyle changes may also be recommended.