Achalasia: Symptoms, Causes & Updated Treatment
Achalasia and Esophageal Motility Disorder: Complete Medical Guide & Best Treatments
Achalasia is a rare esophageal motility disorder that makes swallowing difficult due to failure of the lower esophageal sphincter to relax. Learn about causes, symptoms, diagnosis, diet tips, and modern treatments including POEM, dilation, Heller myotomy, and Botox therapy.
Achalasia
Achalasia is a rare, chronic disorder of the esophagus in which the lower esophageal sphincter (LES) fails to relax properly and the esophageal muscles lose normal movement (aperistalsis). As a result, food and liquids have difficulty passing into the stomach, causing dysphagia, regurgitation, and chest discomfort.
The condition is linked to degeneration of nerves (particularly the myenteric plexus) in the esophageal wall. The exact cause remains unclear, but autoimmune factors, genetic predisposition, and infections such as Chagas disease may contribute.
Key Symptoms
| Symptom | Description |
| Dysphagia | Difficulty swallowing solids and liquids (progressive). |
| Regurgitation | Food or liquids return to the mouth, especially when lying down. |
| Chest pain / pressure | Can mimic heart disease. |
| Heartburn-like sensation | But not true acid reflux at first. |
| Coughing or choking while eating | Due to aspiration risk. |
| Unintended weight loss | Due to reduced intake. |
Unlike acid reflux or esophageal strictures, dysphagia in achalasia affects both solids and liquids early.
Causes & Risk Factors
- Autoimmune nerve destruction in the esophageal wall.
- Genetic predisposition (rare).
- Secondary achalasia may occur in:
- Esophageal cancer
- Chagas disease (Trypanosoma cruzi infection, mostly in South America).
Diagnosis
- Esophageal Manometry (Gold Standard)
Shows:
- Incomplete LES relaxation
- High resting LES pressure
- Absent or weak peristalsis
- Barium Swallow (X-Ray)
Reveals a dilated esophagus with “bird-beak” narrowing at the LES.
- Endoscopy (EGD)
Used to rule out cancer, ulcers, or structural obstructions.
Modern Treatment Options (2025)
There is no cure, but treatments aim to relieve LES pressure and improve swallowing.
| Treatment | Overview | Best For |
| POEM (Peroral Endoscopic Myotomy) | Endoscopic procedure cutting LES muscle from inside | Preferred modern option; high long-term success |
| Heller Myotomy (Laparoscopic) | Surgical division of LES, often with fundoplication to prevent reflux | Long-established effective treatment |
| Pneumatic Balloon Dilation | Balloon is inflated to stretch/tear LES muscle | Non-surgical choice; may need repeats |
| Botulinum Toxin Injection (Botox) | Temporary relaxation of LES | Elderly or high-risk surgical patients |
| Medications (Nitrates, Calcium Channel Blockers) | Reduce LES pressure slightly | Short-term or symptom bridging |
POEM is currently the most preferred first-line definitive therapy
- Minimally invasive
- No external incisions
- High success rate even in advanced cases
Dietary & Lifestyle Management
While diet cannot cure achalasia, the following strategies can reduce discomfort:
- Consume soft or liquid meals
- Eat slowly and chew thoroughly
- Drink water with meals
- Avoid eating near bedtime
- Sleeping with head elevated
- Some patients benefit from carbonated beverages to “push” food through the LES
If weight loss is significant, a complete high-calorie liquid nutritional supplement may be needed.
Complications
- Aspiration pneumonia (due to inhaling regurgitated food)
- Esophagitis
- Esophageal dilation (megaesophagus) in late stages
- Possible increased risk of esophageal cancer over time
When to See a Doctor
Seek medical evaluation if you experience:
- Progressive difficulty swallowing
- Unexplained weight loss
- Frequent choking or coughing during meals
- Persistent heartburn-like discomfort not relieved by antacids
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