DefinitionAchalasia is a disorder of the tube that carries food from the mouth to the stomach (esophagus), which affects the ability of the esophagus to move food toward the stomach.
Alternative NamesEsophageal achalasia
Causes, incidence, and risk factorsA muscular ring at the point where the esophagus and stomach come together (lower esophageal sphincter) normally relaxes during swallowing. In people with achalasia, this muscle ring does not relax as well. The reason for this problem is damage to the nerves of the esophagus.Cancer of the esophagus or upper stomach and a parasite infection that causes Chagas disease may have symptoms like those of achalasia.Achalasia is a rare disorder. It may occur at any age, but is most common in middle-aged or older adults. This problem may be inherited in some people.
SymptomsBackflow (regurgitation) of foodChest pain, which may increase after eating or may be felt in the back, neck, and armsCough
Difficulty swallowing liquids and solidsHeartburnUnintentional weight loss
Signs and testsPhysical examination may show signs of anemia or malnutrition.Tests include:Esophageal manometryEsophagogastroduodenoscopyUpper GI x-ray
TreatmentThe approach to treatment is to reduce the pressure at the lower esophageal sphincter. Therapy may involve:Injection with botulinum toxin (Botox). This may help relax the sphincter muscles, but any benefit wears off within a matter of weeks or months.Medications, such as long-acting nitrates or calcium channel blockers, which can be used to relax the lower esophagus sphincterSurgery (called an esophagomyotomy), which may be needed to decrease the pressure in the lower sphincterWidening (dilation) of the esophagus at the location of the narrowing (done during esophagogastroduodenoscopy)Your doctor can help you decide which treatment is best for your situation.
Expectations (prognosis)The outcomes of surgery and nonsurgical treatments are similar. Sometimes more than one treatment is necessary.
ComplicationsBackflow (regurgitation) of acid or food from the stomach into the esophagus (reflux)Breathing food contents into the lungs, which can cause pneumoniaTearing (perforation) of the esophagus
Calling your health care providerCall your health care provider if:You have difficulty swallowing or painful swallowingYour symptoms continue even with treatment for achalasia
PreventionMany of the causes of achalasia are not preventable. However, treatment of the disorder may help to prevent complications.
ReferencesOrlando RC. Diseases of the esophagus. In: Goldman L, Ausiello DA, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 140.