Achalasia

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The type of treatment you receive depends on the type of achalasia you have. Your specialist will discuss the best options for you.

What is Achalasia?
Achalasia (a-kal-asia) is a rare condition affecting the oesophagus (food pipe) that makes swallowing difficult. It only affects the oesophagus and does not involve other parts of the body.

In achalasia:

• The muscles of the oesophagus are weak and cannot push food effectively into the stomach
• The lower oesophageal sphincter (LES), a ring of muscle at the bottom of the oesophagus, fails to relax properly

How Common is Achalasia?

• Rare: about 1 person per 100,000 in the UK is diagnosed each year
• Affects men and women equally
• Most commonly diagnosed between ages 30–60

What Causes Achalasia?
The exact cause is unknown, but it is linked to problems with the nerves and muscles of the oesophagus. Achalasia is not caused by diet or lifestyle and is not contagious.

Symptoms

The main symptom is difficulty swallowing (dysphagia), which can involve both solids and liquids. Other common symptoms include:

• Feeling food “stuck” in the chest
• Chest discomfort or heartburn
• Regurgitation (food coming back up)
• Coughing, choking, or chest infections
• Gradual weight loss

Symptoms can develop slowly and may be mistaken for other conditions, which can delay diagnosis.

How is Achalasia Diagnosed?
Because achalasia is rare, diagnosis often requires several tests:

• Gastroscopy (OGD): A camera is passed through the mouth to examine the oesophagus and stomach
• High Resolution Manometry: Measures pressures in the oesophagus and LES via a thin tube through the nose
• Barium Swallow: X-ray taken while drinking a contrast liquid to see how food moves down the oesophagus

Your doctor will review your medical history and symptoms to help guide testing, you may require additional tests not mentioned here.

Treatment Options
While there is no cure, treatment can relieve symptoms and improve swallowing:

• Pneumatic Dilatation: Balloon stretches the LES to help food pass; may need repeating; small risk of perforation
• Peroral Endoscopic Myotomy (POEM): Endoscopic procedure cutting LES muscles; improves swallowing but may increase reflux; performed in specialist centres
• Laparoscopic Heller’s Myotomy: Keyhole surgery cutting LES muscles; high success rate (~90%); usually short hospital stay

All procedures carry risks, including temporary difficulty swallowing, reflux, bleeding, infection, and, rarely, serious complications. Your specialist will explain which is most suitable for you.

Living with Achalasia

• Achalasia is a long-term condition; symptoms may return over time
• Dietary adjustments (smaller meals, chewing well, moist foods) can help
• Regular follow-up with your specialist is important to monitor symptoms