Achalasia 

  • Overview

Introduction 

Endoscopy

Find out what an endoscopy procedure is, what happens and how you can prepare yourself for it.

Media last reviewed: 16/03/2013

Next review due: 16/03/2015

Cancer risk

If the gullet contains a large amount of food that does not pass into the stomach in the normal way, the risk of cancer of the oesophagus (gullet) is slightly increased. It's therefore important to get appropriate treatment for achalasia straight away, even if your symptoms are not bothering you.

According to Cancer Research UK, compared with the general population:

  • men with achalasia have an eight to 16 times higher risk of oesophageal cancer 
  • women with achalasia have a 20 times higher risk of one particular type of oesophageal cancer (adenocarcinoma)

NB  cancer of the oesophagus is very uncommon and although your risk is slightly increased, it remains very unlikely.

Achalasia means that your gullet has lost its ability to move food along and the valve at the end of your gullet fails to open to allow food to pass into your stomach.

As a result, food gets stuck in your gullet and is often brought back up. 

A ring of muscle called the cardiac (or lower oesophageal) sphincter keeps the opening from the gullet to the stomach shut tight to prevent acid reflux (acidic stomach content moving back up into the gullet).

Normally, this muscle relaxes when you swallow to allow the food to pass into your stomach. In achalasia, this muscle does not relax properly and the end of your gullet becomes blocked with food.

Achalasia is an uncommon condition that affects about 6,000 people in Britain. It is sometimes known as cardiospasm.

What are the symptoms?

Symptoms of achalasia may start at any time of life and usually come on gradually.

Most people with achalasia have dysphagia, a condition where they find it difficult and sometimes painful to swallow food. This tends to get worse over a couple of years.

It may cause you to bring back up undigested food shortly after meals and some of the vomited food may have been held up in your gullet for some time.

Bringing up undigested food can lead to choking and coughing fits, chest pain and heartburn.

Occasionally, vomit may dribble out of your mouth and stain the pillow during the night. If it trickles down your windpipe, it can cause repeated chest infections and even pneumonia.

You may experience gradual but significant weight loss.

However, in some people achalasia causes no symptoms and is only discovered when a chest X-ray or other investigation is performed for another reason.

What is the cause?

Achalasia is caused by damage to and loss of the nerves in the gullet wall. The reason for this is unknown, although it could be due to a viral infection earlier in life.

There is no evidence to suggest that achalasia is an inherited illness. Women with achalasia can have a normal pregnancy and there's no reason why their children will not develop normally.

How is it diagnosed?

If your GP thinks you have achalasia, you will be referred to hospital to have some diagnostic tests performed.

Barium swallow

A barium swallow involves drinking a white liquid containing the chemical barium, which allows the gullet to be seen and videoed on an X-ray.

In achalasia, the exit at the lower end of your gullet never opens properly, which causes a delay in barium passing into your stomach.

An ordinary chest X-ray may show a wide gullet.

Endoscopy

A flexible instrument called an endoscope is passed down your throat to allow the doctor to look directly at the lining of your gullet and stomach. Trapped food will be visible.

The endoscope can be passed through the tight valve at the bottom of your gullet and into your stomach to check that there is no other disorder of the stomach.

Read more about having an endoscopy.

Manometry

Manometry measures pressure waves in your gullet. A small plastic tube is passed into your gullet through your mouth or nose and the pressure at different points in your gullet is measured.

In achalasia, there are usually weak or absent contractions of the gullet and sustained high pressure in the valve at the lower end of the gullet. It is this high pressure and the failure of the valve to relax in response to a swallow that causes difficulty in swallowing food and food remaining in the gullet.

How is it treated?

The aim of treatment is to disable the valve so that food can pass into the stomach easily. The underlying disease cannot be cured, but there are various ways in which the spasm at the end of the gullet can be reduced and symptoms improved.

Medication

The valve at the lower end of your gullet may be temporarily relaxed by medication. Tablets such as nitrates or nifedipine will only produce a brief improvement in swallowing and are not effective in some patients, but may be useful while a more permanent treatment is planned.

These tablets may cause headaches, but this usually improves with continued treatment.

Dilatation (stretching the valve)

This is done under a sedative or general anaesthetic (where you are put to sleep). A small balloon (about 3-4cm in diameter) is used to stretch and disrupt the muscle fibres of the valve at the lower end of your gullet. This usually improves swallowing. The dilatation may need to be repeated after one or more years.

Botulinum toxin (Botox injection)

Botox causes relaxation of the muscle fibres. It can be injected painlessly into the faulty valve through an endoscope. This is usually effective for a few months and occasionally for a few years, but then has to be repeated.

Surgery

Under general anaesthetic the gullet is accessed through the chest wall or the abdomen (tummy). The muscle fibres that fail to relax are cut, with a permanent improvement in swallowing. The operation is now often performed by keyhole surgery and only requires an overnight stay in hospital.

Recovering from treatment

There are a few things you can do after dilatation or surgery to reduce symptoms:

  • chew your food well
  • take your time eating
  • drink plenty of fluids with your meals
  • always eat food sitting upright
  • use several pillows or raise the head of your bed so that you sleep fairly upright, which prevents stomach acid rising into your gullet through the weakened valve and causing heartburn

If heartburn develops after treatment, consult your GP as medication may be needed to reduce the acid reflux. Sometimes your surgeon may suggest you take this routinely to prevent problems after surgery. Read about treatments for acid reflux

You should also see your GP if you still have swallowing difficulties or are continuing to lose weight.

It's normal for chest pain to persist for a while after treatment  drinking cold water often gives relief.

Page last reviewed: 23/10/2012

Next review due: 23/10/2014

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Comments

The 3 comments posted are personal views. Any information they give has not been checked and may not be accurate.

syedahmads said on 06 November 2014

I have very recently tried Rhodiola Rosa by chance ( can't find anywhere else anyone has tried) which has good neurological properties, I have had great relief in symptoms. and haven't had any vomitting since I have been taking it and the food goes down without issues. I have about 1 year old achalasia and it seems to be responding well. Is there anyone else who has tried this? Since Achalasia is very rare it would be helpful if some experiments are done with this natural herb to find a cure at least in some people.

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JC77 said on 14 April 2014

Hello Frannie, I was diagnosed with this several months back. Some things that have helped me. Eat slow and have room temperature water around while you eat. It helps to get stuff to drop into your stomach. Do not take big drinks though, small drinks to avoid to much fluid and food in your esophagus. At first it was tough because my food portions dropped significantly but as your body gets used to it you will get energy back. I would recommend a good daily vitamin to help replace nutrients. Remember drinking to fast while you eat will cause problems. Drink and eat slow. I try not to eat any later then 6:30pm to make sure all food is out of esophagus before bed. I also sleep nearly straight up. It helps but is hard to get used to. Good luck.

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Frannie 1 said on 10 April 2014

I have been diagnosed with achalasia and was wondering if anyone else suffers with achalasia and how do you cope

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Dysphagia

Dysphagia is a medical term for difficulty with swallowing. Find out about the different causes and treatments for this condition