Understanding Achalasia: Causes, Symptoms, and Diagnosis

what is achalasia

Are you experiencing difficulty swallowing, chest pain, or food regurgitation? 

You might be one of the many individuals battling achalasia. This condition affects the oesophagus (Food pipe) and can significantly impact your quality of life as it can cause varying degrees of swallowing problems, regurgitation or weight loss. 

We will explore what is Achalasia, achalasia causes, symptoms, diagnosis, and treatment options for Achalasia to help you better understand this challenging disorder. 

What is Achalasia?

Achalasia  is a rare disorder that affects the oesophagus (food pipe), the muscular tube connecting the throat to the stomach. In individuals with Achalasia, the lower oesophagal sphincter (LES) which is a muscular valve that  fail to relax properly, causing difficulty in allowing food to pass food into the stomach. The propulsive function of the muscular oesophagus is also impaired causing stagnation, swallowing issues and regurgitation.

Achalasia of the oesophagus results in a backup of food and liquid in the oesophagus, leading to several troublesome symptoms.

The exact cause of Achalasia remains unknown, but it is believed to be related to damage or degeneration of nerve cells in the oesophagus. This can disrupt the regular coordinated muscle contractions required for swallowing and digestion.

Achalasia of esophagus typically progresses slowly over time and can have a significant impact on the ability to eat and drink comfortably.

Types of Achalasia

There are 3 types of Achalasia, differentiated primarily based on the findings of oesophagal manometry, a test used to measures the rhythmic muscle contractions of the oesophagus when you swallow. Here are the three types:

Type I (Classic Achalasia)
  • In Type I achalasia disease, there is minimal to no peristalsis (synchronized propulsive activity) in the oesophagal body, and the lower oesophagal sphincter (LES) fails to relax properly during swallowing. This results in a lack of progressive oesophagal contractions and a dilated oesophagus. Patients with this type typically have severe impairment in oesophagal emptying and may have significant dilation of the oesophagus.


Type II (Achalasia with Compression)
  • Type II achalasia disease is characterized by intermittent periods of pan-oesophagal pressurization where the entire oesophagus presses simultaneously without normal peristaltic movement. This type responds better to treatment than the other types, possibly due to less severe nerve damage. The LES also fails to relax adequately in this type.


Type III (Spastic Achalasia)
  • This type is less common and involves spastic (discoordinated and vigorous) contractions of the oesophagal body in addition to the failure of the LES to relax. These contractions are non-peristaltic and can cause significant pain and discomfort during swallowing.

Achalasia Causes

While the exact reasons behind Achalasia causes remain uncertain, researchers believe that nerve damage in the oesophagus may play a role in disrupting its normal functioning. This nerve damage could be due to an autoimmune response, genetic factors, or viral infections.

Abnormalities in the muscles of the lower oesophagal sphincter (LES) may contribute to Achalasia. The LES is responsible for allowing food and liquids to pass into the stomach; however, in individuals with Achalasia, this muscle fails to relax properly during swallowing. This dysfunction leads to difficulty in moving food down into the stomach and causes symptoms such as dysphagia and chest pain.

While we have some insights into potential causes of Achalasia, such as nerve damage and LES abnormalities, further research is needed to fully comprehend this complex condition.

Achalasia Symptoms

Various Achalasia symptoms can significantly impact a person’s quality of life. One common symptom is dysphagia, which refers to difficulty swallowing food or liquids. This can lead to chest pain, regurgitation of undigested food, and even weight loss due to inadequate nutrient intake.

The sensation of having food stuck in the chest after eating is another distressing symptom of this condition. Additional Achalasia symptoms include:

  • Swallowed food or saliva flowing back into the throat.
  • Belching.
  • Chest pain that comes and goes.
  • Heartburn.
  • Coughing at night.
  • Weight loss.
  • Pneumonia from getting food in the lungs.
  • Vomiting.

Achalasia Diagnosis

Achalasia diagnosis can be a complex process that involves a few tests and procedures to accurately identify the condition. 

  • The oesophagal manometry test, which measures the pressure in the oesophagus as you swallow, is a common method for diagnosing achalasia. It measures the peristaltic potential and the valve relaxation properties.
  • Another test often used is a barium swallow study, where you drink a contrast material that shows up on X-rays to help visualize any abnormalities in the oesophagus. It is the best test to show a dilated oesophagus and narrowing of the valve similar to a ‘rat’s tail’.
  • Endoscopy may also be performed to examine the oesophagus directly using a flexible tube with a camera attached.
  • In some cases, imaging tests like CT scans or MRIs may be ordered to get detailed images of the oesophagus and surrounding structures.

Achalasia treatment

The goal of achalasia treatment is to make food or liquids pass through the digestive tract more smoothly by relaxing or opening the lower oesophagal sphincter. The aim of treatment is purely to improve symptoms as there is no complete cure for Achalasia.  The course of Achalasia treatment will vary based on your age, health, and severity of achalasia.

  • Pneumatic dilation: During this outpatient operation, an inflatable balloon is placed into the esophageal sphincter’s core, widening the opening. If the esophageal sphincter fails to remain open, pneumatic dilation may need to be performed once again.
  • Laparoscopic Heller myotomy: Another achalasia treatment is a surgical procedure that involves cutting the muscles at the lower end of the oesophagus to help food and liquids pass more easily into the stomach.
  • Botox injections: This option temporarily relaxes the sphincter muscles, providing relief from symptoms. However, this achalasia treatment may need to be repeated periodically.
  • Medication: Before eating, your doctor may advise taking muscle relaxants such as nifedipine (Procardia) or nitroglycerin (Nitrostat). These drugs have serious adverse effects in addition to a limited therapeutic benefit. Generally speaking, medications are only considered if Botox has failed and you are not a candidate for pneumatic dilation or surgery. Rarely is this kind of therapy appropriate.
New Treatments for Achalasia

Peroral endoscopic myotomy (POEM) has revolutionized the landscape of new treatments for Achalasia by allowing for a minimally invasive approach to modify the lower oesophagal sphincter. This technique enhances swallowing efficiency and reduces procedural recovery time. 

High-resolution manometry, used during these procedures, also increases the precision of muscle modifications tailored to each patient’s needs.

Additionally, advancements in pharmacological research are introducing new treatments for Achalasia that focus on the neural control of oesophagal motility. These emerging therapies aim to manage symptoms with minimal side effects, offering a promising direction for less invasive treatment options.

Consult Dr Balaji for Upper GI Surgery in Dubai

If you or a loved one are experiencing symptoms of Achalasia, it is essential to seek medical attention for an accurate diagnosis and appropriate treatment. 

Consulting with a specialist like Dr. Balaji at Upper GI Surgery in Dubai can provide expert care and guidance throughout your journey with Achalasia. 

Early detection and intervention can significantly improve one’s quality of life and overall well-being. Don’t hesitate to seek the support one needs to manage Achalasia effectively.


Achalasia is a rare esophageal disorder marked by difficulty in swallowing, regurgitation of food, and sometimes chest pain. This occurs due to the failure of the lower esophageal sphincter to relax properly, impeding the movement of food into the stomach.

The exact achalasia causes are not fully understood but are believed to involve the degeneration of nerves in the esophagus, possibly due to an autoimmune response that affects the body’s nerve cells.

There are  3 types of achalasia are Type I (Classic Achalasia), where there is a complete absence of esophageal contractions; Type II (Achalasia with Compression), characterized by intermittent esophageal pressurization; and Type III (Spastic Achalasia), marked by spastic and uncoordinated contractions.

Achalasia symptoms typically include difficulty swallowing (dysphagia), regurgitation of undigested food, chest pain, weight loss, and sometimes heartburn.

Achalasia diagnosis usually involves an esophageal manometry, which is the most specific test, along with a barium swallow X-ray and upper endoscopy to assess the structure and function of the esophagus.

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