Patient education: Achalasia (The Basics)

What is achalasia? — Achalasia is a condition that affects the esophagus. The esophagus is the tube that moves food from the mouth to the stomach (figure 1). At the lower end of the esophagus, where it connects to the stomach, there is a muscle called the lower esophageal sphincter ("LES"). When the LES tightens, food can't move from the esophagus into the stomach. When the LES relaxes, food can move from the esophagus into the stomach.

When a person has achalasia:

●The lower part of the esophagus does not work normally.

●The LES doesn't relax, so food can't move into the stomach.

What are the symptoms of achalasia? — The most common symptom of achalasia is trouble swallowing foods and drinks.

Other symptoms can include:

●Chest pain

●Vomiting

●Heartburn

●Feeling like you have a lump in your throat

●Losing weight without trying

Is there a test for achalasia? — Yes. If your doctor or nurse suspects that you have achalasia, they will do 1 or more of the following tests:

●Measuring the pressure in your esophagus and LES – Your doctor will put a thin tube into your mouth or nose and down into your esophagus. The tube measures the pressure there. This test can tell your doctor for sure if you have achalasia.

●Barium swallow – Your doctor will give you a drink called "barium." Then, they take an X-ray as the barium moves down your esophagus (figure 2).

●Upper endoscopy – For this procedure, your doctor will put a thin tube with a camera on the end into your mouth and down into your esophagus and stomach (figure 3). They look at the lining of the esophagus and stomach. They might also take a small sample of tissue from the lining and then look at the sample under a microscope.

How is achalasia treated? — Doctors can treat achalasia in different ways. Treatments cannot cure achalasia, but they can improve symptoms. The different treatments include:

●Making the LES wider – During an upper endoscopy, a doctor can use a thin wire to put a special balloon through a person's mouth and down into their esophagus. The balloon is deflated until it reaches the LES. The doctor puts air into the balloon to widen, or "dilate," the LES. Then, they let the air out of the balloon and remove it and the wire.

●Surgery – A doctor can cut open the LES to make it wider. This surgery is called "myotomy." It can be done in 2 ways:

•Surgical myotomy – This is most often done as "laparoscopic" surgery in an operating room. For laparoscopic surgery, a doctor makes small cuts in the belly or chest. Then, they put long, thin tools through the cuts. One of the tools has a camera on the end, which sends pictures to a video screen. The doctor can look at the screen to see inside your body while they do the surgery.

•Peroral endoscopic myotomy ("POEM") – This is a way to do the surgery without making any cuts in the skin. This is done either at an endoscopy center or in an operating room. As with an upper endoscopy, a doctor will put a thin tube with a camera on the end into your mouth and down into your esophagus. Then, they use special tools to cut open the LES from the inside.

●Medicines – Different medicines can relax the LES. People can take these medicines before they eat.

●A shot of medicine into the LES – During an upper endoscopy, a doctor can give a shot of medicine into the LES to make it relax.

Which treatment is right for me? — Talk with your doctor about the different treatments. Ask them about the benefits, risks, and side effects of each treatment. The best choice depends on several things. These include your age, your overall health, whether you can get anesthesia, your doctor's expertise, and your preferences.

Do I need to follow up with my doctor? — Yes. You need to follow up with your doctor regularly. They will check that your treatment is working and that it isn't causing side effects.

Your doctor will also keep checking you for long-term problems. That's because people with achalasia have a higher than normal chance of getting cancer or other problems of the esophagus.

More on this topic

Patient education: Upper endoscopy (The Basics)
Patient education: Acid reflux and GERD in adults (The Basics)

Patient education: Achalasia (Beyond the Basics)
Patient education: Upper endoscopy (Beyond the Basics)
Patient education: Gastroesophageal reflux disease in adults (Beyond the Basics)