Everything you Need to Know …and More
Essential Information about…Achalasia
What is Achalasia?
Achalasia is a disorder of the oesophagus which can make it difficult to swallow food and drink. It occurs when the muscles in the lower part of the oesophagus (the lower oesophageal sphincter, or LES) fail to relax properly, making it difficult for food and liquids to pass into the stomach.
 It is very rare with around 1 in 100,000 new patients being diagnosed each year.
What are the Symptoms of Achalasia?
Symptoms, although not always experienced, can include:
- Difficulty swallowing (dysphagia) which may affect both solids and liquids
- Regurgitation (bringing food back up)
- Choking and coughing
- Heartburn
- Chest pain
- Drooling
- Weight loss
- Chest infections which don’t go away or come back frequently.
If you have any of these symptoms or you are having difficulty swallowing, please contact your GP immediately as you will need to start treatment straight away.
What Causes Achalasia?
The lower oesophageal sphincter (LES) is a muscular ring located between the oesophagus and the stomach, acting as a valve to prevent food and fluids from flowing back into the oesophagus. Achalasia occurs when the nerves and muscles in the lower part of the oesophagus deteriorate, preventing the LES from relaxing properly.Â
This makes it difficult for food and liquids to pass into the stomach. Furthermore, the muscles of the oesophagus lose their ability to contract in a coordinated manner, further hindering the movement of food down the oesophagus.Â
Over time, the oesophagus may become enlarged (dilated). Although the cause of achalasia is often unknown, in rare cases, it can be triggered by specific infections.
How is Achalasia Diagnosed?
The non-specific nature of the symptoms and the rarity of the condition can lead to delays in diagnosis. When achalasia is suspected, typically based on the patient’s symptoms, various tests are required to confirm the diagnosis. These tests include:
Oesophageal manometry: This is the primary test for diagnosing achalasia. It measures pressure in the oesophagus. A small plastic tube with pressure sensors is inserted through the nose into the oesophagus. Over a period of thirty minutes, the sensors assess the oesophagus’s function and detect any abnormalities.
Barium swallow: In this test, the patient drinks a white liquid called barium, which outlines the oesophagus under an X-ray or similar imaging. It helps determine the shape of the oesophagus and can reveal whether it has become enlarged, often used alongside manometry.
Endoscopy: A thin tube with a camera at the end is inserted through the mouth into the oesophagus and stomach. This test helps identify other possible causes for the symptoms.
Treatment
There is no cure, but treatments can help manage symptoms. These include:
- Medications: To relax the oesophageal muscles
- Balloon dilation (pneumatic dilation): A balloon is inflated in the oesophagus to widen the lower oesophageal sphincter
- Surgery (Heller myotomy): The muscle fibres of the lower oesophageal sphincter are cut to allow easier food passage
- Botox injections: Temporarily paralyse the muscles to provide relief
Without treatment, achalasia can worsen over time, potentially leading to complications like malnutrition or aspiration (food entering the lungs).
