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View this article online at: patient.info/health/achalasia-leaflet

Achalasia
Achalasia is an uncommon condition that affects the muscles of your gullet (oesophagus). It usually
causes difficulty in swallowing both food and fluids. There are different treatments available which
can improve symptoms.

What is the oesophagus?

The gullet (oesophagus) contains muscles. These muscles contract in a rhythmic way to allow your food to pass
down your oesophagus. This is known as peristalsis. At the lower end of your oesophagus there is a ring of
muscle called a sphincter. This sphincter relaxes to allow food to pass from the oesophagus into your stomach.
But, the sphincter contracts when no food is passing down, to stop food passing back up (refluxing) into the
oesophagus.

What is achalasia?
In the gullet (oesophagus) there are both muscles and nerves. Achalasia affects both the muscles and the nerves
of the oesophagus, especially initially the nerves that cause the sphincter between the oesophagus and stomach
to relax. The muscles do not contract properly so the rhythmic contraction of muscles, which allows your food to
pass down your oesophagus (peristalsis), does not occur correctly. In addition, the sphincter does not relax
properly so food cannot pass through into your stomach easily. This makes it difficult for you to swallow food
properly.

The main part of your oesophagus then becomes enlarged and widened (dilated) with time.
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How common is achalasia and who is affected by it?
Achalasia is a very uncommon condition. Less than 1 in 100,000 people in the UK are diagnosed with it each
year. It mainly affects adults aged between 20-40 years. In most cases, no underlying cause can be found and
the reason why the nerves and muscles in the gullet (oesophagus) do not work so well is not clear. It is more
common in people with Chagas' disease (an infectious disease more common in South America), Parkinson's
disease and stomach cancer. However, the majority of people with these conditions do not have achalasia.

What are the symptoms of achalasia?

The most common symptom is difficulty in swallowing (dysphagia) both food and liquids. You may also notice
that some of your food feels as if it is sticking in your chest after you have eaten. It can also be common to lose
weight, as you cannot swallow all your food. You may also have some chest pains or a heavy sensation on your
chest. Some people also develop a cough, which is sometimes worse at night. Heartburn is also fairly common.

As your gullet (oesophagus) dilates, you may find that some of your food is brought back up (regurgitated). If this
happens during the night you may experience some choking or coughing.

What are the tests for achalasia?

Most people will have had achalasia for a length of time, even for years, before the diagnosis is made. Various
tests may be advised if your doctor thinks you may have achalasia. These usually include one or more of the
following:

Barium swallow
This is a specialised X-ray test. In this test, X-rays of your gullet (oesophagus) are taken after you swallow a liquid
called barium, which shows up as white on the X-ray. This test will show if your oesophagus has widened
(dilated). It will also show if the barium stays in your oesophagus for longer than normal. See separate leaflet
called Barium Swallow/Meal/Follow Through for more details.

Manometry
In this test, the pressure that is generated within your oesophagus when you swallow is monitored. During this
test, a thin tube is placed through your nose, down the back of your throat and into your oesophagus. This test
can often detect earlier changes than a barium swallow can.
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Gastroscopy - sometimes called endoscopy
A gastroscope (endoscope) is a thin, flexible telescope. It is passed through the mouth, into the oesophagus and
down towards the stomach and the first section of the intestine (the duodenum). The endoscope contains fibre-
optic channels which allow light to shine down so the doctor or nurse can see inside your oesophagus, stomach
and duodenum. See separate leaflet called Gastroscopy (Endoscopy) for more details.

What are the treatment options for achalasia?

There are different treatments available. These include:

Medication
Various medicines can help to relax the sphincter at the lower end of the gullet (oesophagus). Examples include
calcium-channel blockers (such as nifedipine) and nitrates (such as isosorbide dinitrate). These work best when
achalasia is first diagnosed. However, they usually only work in the short term and are most often prescribed for
people who cannot have other forms of treatment.

Dilatation
This is a procedure in which the sphincter is made wider (dilated). This is done by using a balloon which is
inflated to stretch the sphincter. This is done with the use of a gastroscope, to ensure the balloon is in the correct
position.

Surgery
In some cases, the muscle fibres in the sphincter are divided (cut) during an operation. This is often done by
keyhole surgery. This is usually very successful at easing the symptom of difficulty swallowing. However, it may
cause complications such as gastro-oesophageal reflux disease. This is a condition where the acid from your
stomach comes up into your oesophagus. This can cause heartburn.

Botulinum toxin
This is another method of treating achalasia. Botulinum toxin acts as a muscle relaxant and is injected into the
sphincter to weaken the muscle. This is usually a safe treatment. However, it only works for a few months, so
further injections are often necessary. It may be more suitable for people who are unable to have surgery.

What are the possible complications of achalasia?

The main complication of achalasia is weight loss. Another possible complication is that if food is brought up
again (regurgitated), there is a risk that some food can enter the lungs. This can then lead to an infection in the
lungs. This type of infection is known as aspiration pneumonia. It is usually treated with antibiotic medicines but it
can be more difficult to treat than other types of pneumonia. You are also at increased risk of developing some
inflammation of the lining of your gullet (oesophagus), due to the food and fluid which collect in your gullet and
cause irritation. This is called oesophagitis.

There are also possible complications of some of the treatments. For example, widening (dilatation) of the
sphincter can sometimes lead to a puncture (perforation) of the oesophagus. If this occurs, it will need an
emergency operation to repair it.

There is a slightly increased risk of developing cancer of the oesophagus if it contains a large amount of food
which does not pass into the stomach in the normal way. Your doctor will be able to discuss this with you in more
detail.

Further reading & references

Gockel I, Muller M, Schumacher J; Achalasia - a disease of unknown cause that is often diagnosed too late. Dtsch Arztebl
Int. 2012 Mar;109(12):209-14. doi: 10.3238/arztebl.2012.0209. Epub 2012 Mar 23.
Eckardt AJ, Eckardt VF; Current clinical approach to achalasia. World J Gastroenterol. 2009 Aug 28;15(32):3969-75.
Campos GM, Vittinghoff E, Rabl C, et al; Endoscopic and surgical treatments for achalasia: a systematic review and meta-
analysis. Ann Surg. 2009 Jan;249(1):45-57.
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Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical
conditions. EMIS has used all reasonable care in compiling the information but makes no warranty as to its
accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions.
For details see our conditions.

Original Author: Current Version: Peer Reviewer:

Dr Louise Newson Dr Nick Imm Dr Laurence Knott
Document ID: Last Checked: Next Review:
12569 (v3) 11/08/2016 11/08/2019

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