Achalasia is a rare disorder that causes problems with swallowing. It is caused by nerve damage that prevents the muscles in your esophagus from working together to move food from your throat to your stomach.
Learn how UPMC experts provide advanced surgical and nonsurgical care for achalasia, helping to improve swallowing safety and enhance your quality of life.
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What Is Achalasia?
Achalasia is a rare disorder that causes problems with swallowing. It is caused by nerve damage that prevents the muscles in your esophagus from working together to move food from your throat to your stomach.
Achalasia can also prevent your lower esophageal sphincter (LES) — a ring of muscle located where your esophagus and stomach meet — from opening to allow food to pass through. When your LES doesn’t relax properly and stays closed, food may back up into your esophagus instead of passing into your stomach.
What are the types of achalasia?
There are three primary types of achalasia, including:
- Classic achalasia (Type I) — There are no muscle contractions to help move food through your esophagus, and a LES that does not relax.
- Achalasia with esophageal compression (Type II) — There are contractions in the entire esophagus that increase the pressure in it, but don’t push food down, and a LES that does not relax.
- Spastic achalasia (Type III) — Abnormal muscle contractions, often in the lower part of your esophagus, that can sometimes cause chest pain, but don’t push food through. The LES does not relax.
How common is achalasia?
Achalasia is a rare condition that affects approximately 1 in 100,000 people worldwide.
What causes achalasia?
Achalasia is caused by damage to the nerves that control the muscles in your LES and esophagus — the tube that food passes through on its way from your mouth to your stomach. However, researchers aren’t sure what causes this type of nerve damage.
Achalasia risk factors
You may be at higher risk of developing achalasia if:
- You are between the ages of 25 and 60.
- You have a family member with achalasia.
- You have an injury to your spinal cord or esophagus.
- You have a weakened immune system due to autoimmune disorders or infections.
- You have been diagnosed with a parasitic infection called Chagas disease.
Complications of achalasia
One of the main complications of achalasia is regurgitation, which happens when food backs up into your esophagus. This backup can lead to aspiration, which occurs when regurgitated food is inhaled into the lungs. Aspiration can lead to pneumonia and lung infections.
How can I prevent achalasia?
There is nothing you can do to prevent achalasia. However, getting early treatment can improve your quality of life and lower your risk of complications.
What Are the Signs and Symptoms of Achalasia?
Symptoms of achalasia often develop slowly. Difficulty swallowing is usually the first noticeable symptom.
Other symptoms of achalasia may include:
- Chest pain during or after eating.
- Cough.
- Difficulty swallowing.
- Heartburn.
- Regurgitation of food.
- Unintentional weight loss.
Why does achalasia cause weight loss?
Achalasia prevents food from traveling through your esophagus and into your stomach. As a result, you may consume fewer calories than your body needs to function, which can result in unintentional weight loss.
When should I see a doctor about my achalasia symptoms?
If you notice symptoms of achalasia, schedule an appointment with your doctor right away. Early treatment may improve your outcomes and prevent regurgitation, aspiration, or other complications.
How Do You Diagnose Achalasia?
Your doctor may recommend getting tested for achalasia if you have difficulty swallowing or other symptoms.
What to expect during your visit
If your doctor suspects achalasia, they will:
- Ask about your symptoms.
- Perform a physical exam.
- Order other tests.
- Review your health history and medications.
Tests to diagnose achalasia
Tests to diagnose achalasia include:
- Esophageal manometry — Checks to see if your esophagus is working properly.
- Esophagram — An x-ray of your esophagus
- Functional luminal imaging probe (FLIP) — Creates a 3D image of your esophagus and how it moves.
- Upper endoscopy (EGD) — Checks the lining of your esophagus using a flexible tube with a camera called an endoscope.
Achalasia prognosis
Most cases of achalasia improve with surgical or nonsurgical treatment. However, you may need routine follow-up care and additional treatment over time. Your doctor will recommend a treatment approach to help you manage symptoms and improve your quality of life.
What is the life expectancy of someone with achalasia?
Most people with achalasia have a normal life expectancy.
Does achalasia heal on its own?
Achalasia is caused by nerve damage, making it a lifelong condition that does not heal on its own. However, ongoing treatment can help to control symptoms and reduce your risk of complications.
How Do You Treat Achalasia?
The goal of achalasia treatment is to allow food and liquids to pass into your stomach.
Treatment may include:
Botox injections for achalasia
Your doctor may recommend Botox (botulinum toxin) injections to help relax your LES. Botox injections provide symptom relief for a few weeks or months and need to be repeated over time.
Medications to treat achalasia
Your doctor may prescribe medications to relax your LES. However, medications are not effective for everyone, and surgical care may be required.
Esophageal dilation for achalasia
During an upper endoscopy procedure (EGD), your doctor will inflate a balloon to dilate, or stretch, narrowed areas of your esophagus.
Minimally invasive or endoscopic surgery for achalasia
The standard treatment for achalasia is to cut the muscle fibers of the LES so it will open. This procedure can be done surgically or endoscopically.
A Heller myotomy is a minimally invasive surgery, where your surgeon will make small incisions in the external muscular tissues of your lower esophagus and stomach. The incisions reduce pressure, allowing food to pass easily through your LES and into your stomach.
A peroral endoscopic myotomy (POEM) procedure is an advanced endoscopic procedure where the muscle fibers of the LES are cut endoscopically, from the inside. Some types of achalasia are not appropriate for POEM.
Most people can return home as early as one to two days after surgery.
Why Choose UPMC for Achalasia Care?
When you choose UPMC for achalasia care, you will receive:
- Access to board-certified specialists — Our gastrointestinal and thoracic surgery specialists are experienced in caring for people with achalasia.
- Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce discomfort and improve your quality of life.
- A full range of treatment options — We use the latest nonsurgical, minimally invasive, and surgical techniques to provide comprehensive care. We also partner with speech and swallowing therapists to optimize your care.
