A Patient’s Story
Maria, 41, noticed that food often felt “stuck” in her chest. Over time, eating became stressful. She began avoiding solid foods and lost weight without trying.
Despite treatment for acid reflux, her symptoms persisted. Further specialist testing revealed the real cause: achalasia.
What Is Achalasia?
Achalasia is a rare disorder of the oesophagus (food pipe) that affects the way food and liquid pass from the mouth into the stomach.
In achalasia:
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The lower oesophageal sphincter (LOS) fails to relax properly
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The oesophagus loses its normal muscular contractions (peristalsis)
As a result, food builds up in the oesophagus instead of moving smoothly into the stomach.
How Common Is Achalasia?
Achalasia is uncommon, affecting approximately 1 in 100,000 people per year.
It can occur at any age but is most often diagnosed between 30 and 60 years.
Common Symptoms of Achalasia
Symptoms usually develop gradually and worsen over time.
Typical symptoms include
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Difficulty swallowing (dysphagia) for solids and liquids
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Regurgitation of undigested food
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Chest pain or discomfort
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Unintentional weight loss
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Night-time coughing or choking
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Heartburn-like symptoms that do not respond to acid suppression
Because symptoms can mimic reflux disease, diagnosis is often delayed.
What Causes Achalasia?
Achalasia is caused by damage to the nerves controlling the oesophagus, particularly those responsible for muscle relaxation.
The exact cause is unknown, but contributing factors may include:
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Autoimmune processes
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Viral triggers
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Degeneration of oesophageal nerve cells
It is not caused by diet, stress, or acid reflux.
How Is Achalasia Diagnosed?
Diagnosis requires specialist investigation.
Common tests include:
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Oesophageal manometry (gold standard test)
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Barium swallow X-ray
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Upper endoscopy to rule out cancer or strictures
These tests assess oesophageal movement and sphincter function.
Types of Achalasia
Achalasia is classified into subtypes based on manometry findings:
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Type I (Classic): minimal oesophageal movement
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Type II: oesophageal pressurisation with swallowing
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Type III (Spastic): abnormal, spastic contractions
Identifying the subtype helps guide treatment choice.
Treatment Options for Achalasia
While achalasia cannot be cured, treatment can significantly improve symptoms by reducing sphincter pressure.
Treatment options include:
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Pneumatic balloon dilatation
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Botulinum toxin injections (temporary relief)
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Heller myotomy (surgical muscle division)
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POEM (Peroral Endoscopic Myotomy)
The best option depends on age, achalasia subtype, and symptom severity.
Living With Achalasia
With appropriate treatment and follow-up, most patients experience substantial symptom relief.
Long-term care may include:
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Ongoing monitoring
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Managing reflux after treatment
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Dietary adjustments
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Specialist review if symptoms recur
When to Seek Medical Advice
You should seek urgent specialist assessment if you experience:
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Progressive swallowing difficulty
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Food sticking in the chest
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Persistent regurgitation
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Weight loss
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Chest pain unrelated to exertion
Early diagnosis improves outcomes.
Specialist Assessment for Achalasia
Difficulty swallowing or regurgitating food?
At LSDC Healthcare, we provide specialist evaluation of swallowing disorders, including advanced oesophageal testing and access to modern treatment options for achalasia.