Achalasia Symptoms

Achalasia is a rare condition affecting the esophagus, the tube that carries food from your mouth to your stomach. It makes it hard to swallow food and liquids because the muscle at the bottom of your esophagus (lower esophageal sphincter) doesn't relax properly, and the esophagus itself doesn't push food down effectively. Symptoms usually worsen over time.

What is Achalasia Symptoms?

Achalasia is a rare disorder that affects your esophagus, the muscular tube responsible for moving food from your mouth to your stomach. With achalasia, the ring of muscle at the bottom of your esophagus, called the lower esophageal sphincter (LES), fails to open and relax during swallowing. Additionally, the muscles in the esophagus often lose their ability to push food downwards.

This condition makes it difficult for food and liquids to pass into your stomach, causing them to get stuck in your esophagus. Over time, the esophagus can become dilated, meaning it stretches and widens above the tight LES. Achalasia is considered a chronic condition, meaning it is long-lasting. It is also progressive, which means its symptoms tend to worsen gradually over months or even years if left untreated. While it is a rare disorder, it can significantly impact your quality of life due to the persistent difficulty with eating and drinking.

Symptoms

The main symptom of achalasia is difficulty swallowing, known as dysphagia, which affects both solids and liquids. Other common symptoms include regurgitation of undigested food, chest pain that isn't related to your heart, and unintended weight loss. These symptoms typically develop slowly and become more noticeable over time.

Difficulty swallowing (dysphagia) is almost always the first and most prominent symptom. You might feel like food or drink is stuck in your throat or chest after you swallow. This sensation can be uncomfortable and sometimes painful, and it often gets worse as the condition progresses. Regurgitation is another common symptom, where undigested food and saliva flow back up into your mouth. This often happens hours after eating, and it can be particularly troublesome at night, potentially leading to coughing or choking. In some cases, food or liquid can accidentally enter your windpipe (trachea) and lungs, a process called aspiration, which can cause respiratory problems. Many people with achalasia experience chest pain, which is usually not related to heart problems (non-cardiac chest pain). This pain can feel like pressure or a squeezing sensation in your chest. Heartburn, a burning sensation in the chest, can also occur and may sometimes be mistaken for gastroesophageal reflux disease (GERD), even though the underlying cause is different. Because of the difficulty swallowing and regurgitation, unintentional weight loss is also a frequent symptom as you may struggle to get enough nutrition.

Causes & risk factors

Achalasia is primarily caused by damage to the nerves in your esophagus, which are crucial for muscle function and relaxation of the lower esophageal sphincter. The exact reason why these nerves become damaged is often unknown, but it is not considered a genetic or contagious condition.

The esophagus contains a network of nerves that coordinate the muscle contractions needed to push food down towards the stomach. These nerves also signal the lower esophageal sphincter (LES) to relax and open when you swallow. In achalasia, these nerve cells degenerate or are destroyed, leading to a loss of normal esophageal function. While the precise cause of this nerve damage is unclear in most cases, some research suggests a possible autoimmune link. This means your body's immune system might mistakenly attack its own healthy cells in the esophagus. However, achalasia is not inherited from your parents, nor can it be passed from person to person. There are no specific lifestyle or environmental risk factors that have been definitively identified as causing achalasia.

How it's diagnosed

Diagnosing achalasia typically involves a combination of tests to assess the function and structure of your esophagus. The most definitive test is esophageal manometry, which measures muscle contractions and pressure. Other important tests include a barium swallow and an upper endoscopy.

Esophageal manometry is considered the most accurate test for diagnosing achalasia. During this procedure, a thin, flexible tube is passed through your nose into your esophagus. Sensors on the tube measure the pressure and coordination of muscle contractions in your esophagus as you swallow. It can specifically identify if your lower esophageal sphincter (LES) is not relaxing properly and if your esophageal muscles are not contracting effectively. A barium swallow, also known as an esophagram, is an X-ray examination of your esophagus. You drink a liquid containing barium, which coats the inside of your esophagus, making it visible on X-rays. This test can show if food is getting stuck, if the esophagus is dilated, and if the LES is narrowed, often appearing as a 'bird's beak' shape at the bottom of the esophagus. An upper endoscopy involves a doctor inserting a thin, flexible tube with a camera (endoscope) down your throat to visually examine the lining of your esophagus, stomach, and the beginning of your small intestine. While an endoscopy might not directly diagnose achalasia, it helps rule out other conditions that can cause similar symptoms, such as tumors or strictures, and can show if the esophagus is dilated or inflamed.

Treatment options

While there is no cure for achalasia, various treatments aim to relax or open the lower esophageal sphincter (LES) to improve swallowing and relieve symptoms. Options range from medications and endoscopic procedures like Botox injections or pneumatic dilation, to surgical interventions such as myotomy.

Medications, such as nitrates or calcium channel blockers, can sometimes be prescribed to relax the LES. However, these drugs are generally less effective than other treatments and often provide only temporary relief. They are typically considered for people who cannot undergo more invasive procedures or as a short-term solution. Endoscopic procedures are often used. Botulinum toxin (Botox) can be injected directly into the LES during an endoscopy to temporarily paralyze the muscle and help it relax. The effects usually last for several months, so repeat injections are often needed. Pneumatic dilation is another endoscopic procedure where a special balloon is inserted into the LES and inflated to stretch and widen the muscle, allowing food to pass more easily. This procedure may need to be repeated over time. Surgical options include a Heller myotomy, which is a laparoscopic procedure where the muscle fibers of the LES are cut to permanently relax it. Another advanced endoscopic procedure is peroral endoscopic myotomy (POEM), where an endoscope is used to cut the LES muscle from inside the esophagus, without external incisions. Both myotomy procedures are generally very effective at providing long-term relief from achalasia symptoms by permanently weakening the LES. Your doctor will discuss the best treatment approach based on your specific condition and overall health.

Recovery & outlook

Achalasia is a chronic condition that cannot be cured, but its symptoms can be effectively managed with various treatments. Most people experience significant improvement in their ability to swallow and overall quality of life after treatment, though lifelong management and follow-up care are typically necessary.

After successful treatment, many individuals find that their difficulty swallowing (dysphagia) and regurgitation are greatly reduced, allowing them to eat more comfortably and maintain a healthy weight. The goal of treatment is to relieve symptoms and prevent complications, as the underlying nerve damage in the esophagus remains. Without treatment, achalasia can lead to serious complications such as malnutrition, significant weight loss, and aspiration pneumonia from food entering the lungs. While treatments can greatly improve symptoms, they do not restore the normal function of the esophagus. Therefore, some people may still experience mild symptoms or require repeat procedures over time. There is a slightly increased risk of developing esophageal cancer in people with long-standing achalasia, even after treatment. For this reason, your doctor may recommend regular endoscopic surveillance to monitor for any changes in the esophageal lining. Regular follow-up with your healthcare provider is important to monitor your condition and ensure the long-term effectiveness of your treatment.

When to see a doctor

You should see a doctor if you experience persistent difficulty swallowing, especially if it affects both solids and liquids, or if you are losing weight unintentionally. Seek immediate medical attention if you have severe chest pain, choking, or difficulty breathing, as these could indicate a serious complication.

If you frequently feel like food is getting stuck in your throat or chest, or if you are regularly regurgitating undigested food, it is important to consult a healthcare professional. These symptoms, particularly when they worsen over time, warrant medical evaluation to determine the cause and receive appropriate care. Unexplained weight loss is another significant symptom that should prompt a visit to your doctor. Difficulty eating due to achalasia can prevent you from getting adequate nutrition, leading to unhealthy weight loss and potential deficiencies. Early diagnosis and treatment can help prevent these complications. While achalasia can cause chest pain, severe or sudden chest pain, especially if accompanied by shortness of breath, sweating, or pain radiating to your arm or jaw, should be evaluated immediately in an emergency setting to rule out heart-related issues. Similarly, if you experience severe choking episodes or significant difficulty breathing, seek urgent medical care.

Frequently asked questions

Is achalasia a common condition?

No, achalasia is considered a rare disorder. It affects a relatively small number of people compared to more common digestive conditions.

Can achalasia be cured?

No, achalasia cannot be cured because the nerve damage in the esophagus is permanent. However, various treatments are highly effective at managing symptoms and significantly improving your ability to swallow and your quality of life.

What is the main symptom of achalasia?

The main symptom of achalasia is difficulty swallowing, medically known as dysphagia. This difficulty typically affects both solid foods and liquids, and it tends to worsen gradually over time.

Does achalasia cause heartburn?

Yes, achalasia can cause symptoms that feel like heartburn, a burning sensation in the chest. These symptoms can sometimes be mistaken for gastroesophageal reflux disease (GERD), even though the underlying cause of the discomfort is different in achalasia.

How quickly do achalasia symptoms get worse?

Achalasia symptoms typically develop slowly and progressively worsen over months or even years. The condition is chronic, meaning it is long-lasting, and its effects on swallowing usually become more noticeable over time if left untreated.

Can achalasia lead to cancer?

Yes, people with long-standing achalasia have a slightly increased risk of developing esophageal cancer, even after treatment. For this reason, your doctor may recommend regular check-ups and endoscopic surveillance to monitor your esophagus.

Sources

• MedlinePlus — Achalasia Symptoms
• Mayo Clinic — Achalasia Symptoms
• Cochrane Library — Achalasia Symptoms