Achalasia

Achalasia is a disorder that affects the part of the body that moves food from the mouth to the stomach (esophagus). This disorder makes it difficult for the esophagus to move liquids and food into the stomach. As a result, swallowing is more difficult. Achalasia affects the muscle between the esophagus and the stomach (lower esophageal sphincter, LES). Normally, this muscle relaxes after you swallow. With achalasia, it does not relax, and there is increased pressure in this area.

What are the causes?

The cause of this condition is not known.

What increases the risk?

• You are 30–60 years old.
• You have a family history of achalasia.
• You have an autoimmune disease, such as:
  • Diabetes.
  • Hypothyroidism.
  • Sjögren's syndrome.
  • Systemic lupus erythematosus.

What are the signs or symptoms?

• Difficulty swallowing or pain when swallowing.
• Food moving up from your stomach to your mouth (regurgitation).
• Weight loss.
• Coughing or wheezing.
• Heartburn.
• Difficulty burping.
• Vomiting.
• Bad breath (halitosis).
• Chest pain.

How is this diagnosed?

• Your symptoms, your medical history, and a physical exam.
• Tests, such as:
  • X-rays.
  • Barium swallow study. In this test, X-rays are taken of your esophagus after you swallow a white liquid (barium) that shows up well on X-rays.
  • Endoscopy. In this test, your health care provider looks at your esophagus using a small, flexible tube that has a video camera at the end (endoscope).
  • Esophageal manometry. This test checks to see if increased pressure is affecting your LES.

How is this treated?

• Medicines.
• Stretching or widening (dilating) your LES. This is done with an endoscopy procedure that involves using a balloon to stretch out the lower esophagus.
• Surgery to reduce pressure in your LES. This may be done with an endoscopy procedure that involves cutting or removing thickened muscle in the area.
• An injection of a muscle-relaxing medicine (botulinum toxin) into the LES.

Follow these instructions at home:

Eating and drinking

• Do not eat or drink while you are reclined or lying down.
• Eat your food slowly.
• Cut food into small pieces.
• Try to eat soft food that is easier to swallow.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not use any products that contain nicotine or tobacco. These products include cigarettes, chewing tobacco, and vaping devices, such as e-cigarettes. If you need help quitting, ask your health care provider.
• Keep all follow-up visits. This is important.

Contact a health care provider if:

• Your symptoms do not go away after treatment.
• You have a fever.
• You have any new symptoms.
• Your pain is worse.

Get help right away if:

• You vomit blood.
• You have chest pain.
• You have difficulty breathing.
• You develop a swelled (distended) abdomen.

Summary

• Achalasia is a disorder that affects the part of the body that moves food from the mouth to the stomach (esophagus). It also affects the muscle between the esophagus and the stomach (lower esophageal sphincter, LES).
• Achalasia may cause difficulty swallowing or pain when swallowing.
• The cause of this condition is not known.
• There is no cure for achalasia, but treatment can help to manage your symptoms.