Menu   WellSpan Health

Health Library

Health Library

Achalasia

Achalasia is a disorder that affects your esophagus, which is the swallowing tube that connects the back of your throat to your stomach. If you have achalasia, your esophagus does not sufficiently push food or liquid into your stomach. In addition, the ring of muscle that circles the lower portion of your esophagus does not relax enough to let food and liquid pass through easily. In fact, achalasia means "failure to relax."

Achalasia usually develops slowly, making it harder for you to swallow food and beverages. It's caused by loss of the nerve cells that control the swallowing muscles in the esophagus. Why these nerve cells degenerate, however, isn’t known. Although achalasia has no cure, symptoms can be controlled with treatment.

Symptoms

Symptoms of achalasia develop gradually. As the esophagus becomes wider and weaker, you may have these symptoms:

  • Difficulty swallowing food, a condition called dysphagia

  • Food or liquid flowing back up into your throat, or regurgitation

  • Waking up at night from coughing or choking because of regurgitation

  • Heartburn

  • Chest pain or pressure

  • Difficulty burping or hiccups

  • Weight loss 

Who's at risk

Achalasia can develop at any age, but it occurs most often between ages 30 and 60. Men and women are equally at risk. Scientists don’t know exactly why this loss of muscle control in the lower esophagus happens, but risk factors may include:

  • Genes you are born with

  • A disordered immune system that attacks the nerve cells in your esophagus

  • The herpes simplex virus or other viral infections 

Diagnosis

If your doctor suspects achalasia from your symptoms, he or she may order 3 tests to confirm your diagnosis:

  • Endoscopy. This is an outpatient procedure during which a flexible telescope is passed through your mouth to examine your esophagus and the valve that opens into your stomach. This valve is called the lower esophageal sphincter (LES).

  • Esophogram. This is a special type of X-ray that takes pictures of your esophagus while you swallow a thick contrast material called barium. Signs of achalasia that your doctor looks for are widening of the esophagus, incomplete emptying, and tightness of your LES.

  • Manometry. This is an outpatient procedure during which a pressure-measuring tube is passed through your nose into your esophagus. Pressure measurements are taken as you swallow sips of water. This test may show weak and uncoordinated muscle contractions and pressure buildup at your LES.  

Treatment

No treatment can restore normal esophageal movement, but treatments can help relieve your symptoms, open up your LES to improve emptying of your esophagus, and prevent complications. You may also need repeat treatments.

These are common treatments:

  • Pneumatic dilation. This is an outpatient procedure done under anesthesia. While your doctor looks into your esophagus through an endoscope, an air-filled balloon is passed through the valve between the esophagus and stomach and then inflated. You may need more than one treatment to get relief.

  • Botox injection. Botox is a medication that can paralyze muscles. Botox can be injected into the muscles that control your LES to relax the valve opening. This procedure is also done during endoscopy, but you don’t need to be asleep. The results usually wear off in 3 months to one year, so the procedure may need to be repeated.

  • Surgery. Surgery to open your LES is called myotomy. During myotomy, the muscles of that valve are cut. This type of surgery usually provides long-term relief from achalasia symptoms.

  • Medications. Two commonly used medications to treat achalasia are calcium channel blockers and long-acting nitrates if surgery is not an option.

Complications

Although you can’t prevent achalasia, treatment can prevent long-term complications. Possible complications include:

  • Aspiration pneumonia. This type of pneumonia may be caused when food or liquids in your esophagus back up into your throat and you breathe them into your lungs.

  • Esophageal perforation. This complication may occur if the walls of your esophagus become weak and distended. Perforation may also occur during treatment. Esophageal perforation may cause a life-threatening infection.

  • Esophageal cancer. People with achalasia are at higher risk for esophageal cancer.  

When to call the doctor

Call your doctor if you have any questions about your medications or treatment. Let your doctor know right away if you have any of these symptoms:

  • Increased difficulty swallowing

  • Worsening regurgitation, especially if you are waking up coughing or choking at night

  • Symptoms of infection such as chills or fever

  • Chest pain or difficulty breathing 

Living with achalasia

Achalasia is a long-term disease, so it's important to learn as much as you can about it and work closely with your medical team. Your health providers will need to follow you on a regular basis, usually once or twice a year, even after symptoms have been controlled. Keep all your appointments. Your doctor may also want to repeat endoscopy and an esophogram.

Here are some lifestyle changes that may help you if you have symptoms of dysphagia or regurgitation:

  • Stop smoking.

  • Avoid foods or beverages that give you heartburn.

  • Drink plenty of fluid when eating and chew your food well.

  • Eat more frequent, smaller meals.

  • Avoid overeating late at night.

Achalasia - WellSpan Health

Author: Iliades, Chris, MD
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Pierce-Smith, Daphne, RN, MSN, CCRC
Last Review Date: 2015-03-04T00:00:00
Last Modified Date: 2015-03-09T00:00:00
Published Date: 2015-03-09T00:00:00
Last Review Date: 2012-12-14T00:00:00
© 2015 WellSpan Health. All Rights Reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

I would like to:

Are you sure you would like to cancel?

All information will be lost.

Yes No ×

About the provider search

This search will provide you with WellSpan Medical Group and Northern Lancaster County (Ephrata) Medical Group primary care physicians and specialists. If we don’t have a WellSpan Medical Group physician to meet your criteria, the search will expand to include community physicians who partner with WellSpan Medical Group physicians through the WellSpan Provider Network or provide care to patients on the Medical Staffs of WellSpan’s Hospitals.

×

Schedule Your Next Appointment Online with MyWellSpan

Use your MyWellSpan patient portal any time to view available appointments, and pick the date and time that best suits your schedule.

Go to MyWellSpan

New to this practice?

If you don't have a WellSpan primary care provider and would like to schedule a new patient appointment with a provider who is accepting patients, just log into your MyWellSpan account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to see the offices that are accepting new patients in relation to your zip code. If you are not enrolled in MyWellSpan, go to www.mywellspan.org, call 1-866-638-1842 or speak with a member of the staff at a participating facility to sign up. New patient scheduling not available at all practices/programs.

Already a patient at this practice?

If you already have a relationship with a WellSpan practice, simply log into your account, and go to the Appointment Center section. As you progress through the scheduling process, you will be able to schedule an appointment with any provider or practice that already counts you as a patient. Online scheduling varies by practice/program.

×