What is achalasia?

Achalasia is a rare condition affecting the oesophagus (the food pipe) that prevents food from entering the stomach properly. There is no cure for achalasia, but there are treatments to ease the symptoms.

Achalasia is a health condition that prevents the nerves that control the muscles of the oesophagus and the sphincter from working properly.

Normally, food is pushed down the oesophagus by a series of muscle contractions. It enters the stomach through a valve called the lower oesophageal sphincter. 

When someone has achalasia, their sphincter does not relax and so food can’t pass through. Instead of passing into the stomach, the food can get stuck in the oesophagus or come back up into the mouth. 

Anyone can develop achalasia, but it usually starts between the ages of 20 and 40 and gradually worsens with age. It’s often not clear why it develops. Causes include a virus that damages the nerves of the oesophagus, an autoimmune condition (when your body attacks its own cells), or an infection with Chagas disease, which can destroy nerve cells.

What are the symptoms of achalasia?

The main symptom of achalasia is difficulty swallowing now and then, and gradually this symptom gets worse. People with achalasia have difficulty swallowing both solid food and liquid. 

Other symptoms include:

• regurgitating (vomiting) undigested food, sometimes during your sleep
• feeling like you have a lump in your throat
• chest pain
• heartburn
• coughing or choking
• hiccups
• difficulty burping
• weight loss
• bad breath

One serious complication is that when you bring up food, you might inhale it into your lungs. This can lead to pneumonia. Achalasia can also cause tears in the oesophagus and puts you at a slightly increased risk of cancer.

When should I see my doctor?

Many people don’t have bad symptoms so they don’t bother to see their doctor. But it’s important to have treatment for achalasia to prevent more serious complications, including pneumonia, damage to the lung, inflammation of the oesophagus, or cancer.

If you are worried about your symptoms, you should talk to your doctor.

How is achalasia diagnosed?

If you think you may have achalasia, see your doctor. They may refer you to a specialist gastroenterologist, who will conduct some tests. These tests may include:

• Barium swallow: You drink a liquid containing barium, which makes the inside of your oesophagus and stomach show up on an x-ray.
• Gastrografin swallow: As with a barium swallow, you drink a liquid that will show up on an x-ray.
• Oesophageal manometry: A thin tube, which measures pressure along your oesophagus, is inserted through your mouth or nose. This will show whether the muscles or sphincter aren’t working properly.
• Endoscopy: A thin, flexible tube with a light and camera on the end is inserted through your mouth so the doctor can examine the oesophagus.
• Chest x-ray: This can measure whether your oesophagus is enlarged. 

How is achalasia treated?

Nerves damaged by achalasia can’t be repaired, but a range of treatments can be used to help with the symptoms.

Surgery can reduce pressure at the sphincter. One option is to put a small balloon inside the sphincter and inflate it. This procedure may need to be repeated, and there is a risk of tearing the oesophagus.

If this doesn’t work, you can have an operation called a Heller myotomy to cut the muscle around the sphincter to release tension. There is a chance you might develop gastro-oesophageal reflux disease (GORD) after this surgery.

Another option is to inject botulinum toxin (Botox) into the valve using an endoscope. This can relieve symptoms for about 3 to 12 months.

Medicines can be used to relax the valve, but they often stop working over time and there is a risk of side effects. 

Resources and support

For more information about achalasia and to find a surgeon, visit the Australia and New Zealand Gastric and Oesophageal Surgery Association.