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.

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.

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

When someone has achalasia, their sphincter does not relax, 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.

What are the symptoms of achalasia?

The main symptom of achalasia is occasional difficulty swallowing. Gradually, this symptom may get 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
• coughing or choking
• hiccups
• difficulty burping
• weight loss
• bad breath

You may also have pain associated with achalasia like:

• chest pain
• heartburn

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What causes achalasia?

Achalasia occurs due to damage to the nerves of the oesophagus. This nerve damage usually occurs due to a virus or autoimmune process (when your body attacks its own cells), but the cause is often unknown.

When should I see my doctor?

Many people don’t have significant symptoms, so they don’t bother to see their doctor. But it’s important to have treatment for achalasia to prevent more serious complications.

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.
• Oesophageal manometry: A thin tube, which measures pressure along your oesophagus, is inserted through your mouth or nose. This will show if 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 identify whether your oesophagus is enlarged.

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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. A small balloon may be inflated inside the sphincter to stretch 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 during endoscopy. This can relieve symptoms for about 3 to 12 months.

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

Can achalasia be prevented?

Achalasia can’t be prevented, but early recognition of symptoms and timely treatment can help to prevent complications.

Complications of achalasia

If you bring up food (regurgitate), you might inhale it into your lungs. This can lead to pneumonia.

Other serious complications include damage to the lung, inflammation of the oesophagus or cancer.

Resources and support

Call healthdirect on 1800 022 222 at any time to speak to a registered nurse (known as NURSE-ON-CALL in Victoria) for more information and advice.