By Achalasia is a rare but serious disorder of the esophagus that affects a person’s ability to swallow food and liquids properly. Although uncommon, Achalasia can significantly impact quality of life when left untreated. Many people initially mistake its symptoms for acid reflux or heartburn, which often delays proper diagnosis.
This comprehensive guide explores everything you need to know about Achalasia—including its causes, symptoms, diagnostic procedures, conventional treatments, dietary recommendations, natural support options, and how it differs from GERD.
What is Achalasia?
Achalasia is a chronic motility disorder of the esophagus—the muscular tube that carries food from the mouth to the stomach. In people with Achalasia, two main problems occur:
- The lower esophageal sphincter (LES)—the muscle valve between the esophagus and stomach—fails to relax properly.
- The esophageal muscles lose their normal wave-like contractions (peristalsis) that move food downward.
As a result, food and liquids accumulate in the esophagus instead of entering the stomach. Over time, the esophagus may become enlarged, stretched, and less functional.
Achalasia affects men and women equally and typically appears between ages 25 and 60, though it can occur at any age. It is considered rare, affecting approximately 1 in 100,000 people per year.
Causes of Achalasia
The exact cause of Achalasia is not fully understood, but research suggests it involves damage to the nerves that control esophageal muscles.
1. Nerve Degeneration
The most widely accepted theory is degeneration of nerve cells (ganglion cells) in the esophageal wall. These nerves normally coordinate muscle relaxation and contraction. When they are damaged, the LES remains tightly closed and peristalsis weakens or stops.
2. Autoimmune Factors
Some researchers believe Achalasia may be an autoimmune condition, where the body’s immune system mistakenly attacks the esophageal nerves.
3. Viral Infections
Certain viral infections have been proposed as triggers for immune-mediated nerve damage, although clear evidence is still lacking.
4. Genetic Factors
While Achalasia is generally not inherited, rare familial cases suggest a possible genetic predisposition in some individuals.
5. Secondary Achalasia (Pseudoachalasia)
In rare instances, Achalasia-like symptoms may result from other conditions, including cancers near the gastroesophageal junction. Proper diagnostic evaluation is critical to rule out these causes.
Achalasia Symptoms
The symptoms of Achalasia often develop gradually and worsen over time. Early signs may be subtle and easily confused with acid reflux.
1. Difficulty Swallowing (Dysphagia)
This is the hallmark symptom of Achalasia. People typically have trouble swallowing both solids and liquids—unlike other conditions where solids are more problematic.
2. Regurgitation
Undigested food may come back up into the mouth, especially when lying down. This can lead to coughing or choking during sleep.
3. Chest Pain
Some individuals experience chest discomfort or pressure, sometimes mistaken for heart-related pain.
4. Weight Loss
Difficulty eating often leads to unintentional weight loss and malnutrition.
5. Heartburn-like Symptoms
Although Achalasia is not acid reflux, food retention can cause irritation and a burning sensation.
6. Chronic Cough or Aspiration
Food or liquid entering the airways can cause coughing, pneumonia, or respiratory infections.
If these symptoms persist, medical evaluation is essential. Delayed treatment may lead to complications such as esophageal dilation or increased risk of esophageal cancer.
How Achalasia Is Diagnosed
Because Achalasia symptoms overlap with other digestive disorders, accurate diagnosis requires specialized testing.
1. Esophageal Manometry (Gold Standard)
High-resolution esophageal manometry measures muscle contractions and LES relaxation. This is the most definitive test for Achalasia and classifies it into subtypes (Type I, II, III), which guide treatment decisions.
2. Barium Swallow (Esophagram)
In this imaging test, the patient swallows a barium solution that coats the esophagus. X-rays reveal a classic “bird’s beak” narrowing at the LES.
3. Upper Endoscopy (EGD)
An endoscope is inserted through the mouth to examine the esophagus and stomach. This helps rule out cancer or structural causes.
Early diagnosis significantly improves treatment outcomes and reduces complications.
Conventional Treatment Options
There is currently no cure for Achalasia, but several effective treatments relieve symptoms by relaxing or weakening the LES.
1. Pneumatic Dilation
A balloon is inserted endoscopically and inflated to stretch and partially tear the LES muscle. This improves swallowing but may require repeat procedures.
2. Heller Myotomy
A surgical procedure in which the LES muscle is cut to allow easier passage of food. It is often combined with partial fundoplication to reduce reflux.
3. Peroral Endoscopic Myotomy (POEM)
A minimally invasive endoscopic technique that cuts the LES from within the esophagus. POEM has become increasingly popular due to its high success rates.
4. Botulinum Toxin (Botox) Injections
Botox relaxes the LES temporarily. This option is generally reserved for older adults or those who cannot undergo surgery.
5. Medications
Calcium channel blockers or nitrates may reduce LES pressure, but they are typically less effective and used when other treatments are not suitable.
Each treatment has risks and benefits. A gastroenterologist helps determine the best approach based on patient age, health status, and Achalasia subtype.
Diet Plan for Achalasia
Dietary adjustments play a crucial role in symptom management.
General Guidelines
- Eat slowly and chew thoroughly.
- Take small bites.
- Drink water with meals.
- Avoid eating before bedtime.
- Remain upright for at least 30–60 minutes after eating.
Recommended Foods
- Soft, moist foods
- Soups and broths
- Smoothies
- Yogurt
- Mashed vegetables
- Scrambled eggs
- Oatmeal
Foods to Avoid
- Dry breads
- Tough meats
- Sticky rice
- Carbonated beverages
- Very spicy or acidic foods
Post-treatment patients, especially those undergoing POEM or myotomy, may need gradual diet progression from liquids to solids.
Natural Remedies for Achalasia
Natural support options cannot replace medical treatment, but they may improve comfort and digestion.
1. Warm Water Therapy
Drinking warm water before meals may help relax esophageal muscles slightly and ease swallowing.
2. Herbal Teas
Chamomile, ginger, or slippery elm tea may soothe irritation and reduce inflammation.
3. Stress Reduction
Stress can worsen esophageal spasms. Techniques such as yoga, meditation, and deep breathing may provide relief.
4. Acupuncture
Some individuals report symptom improvement with acupuncture, though scientific evidence is limited.
5. Nutritional Support
If weight loss is significant, protein shakes and nutrient-dense smoothies can help maintain calorie intake.
Always consult a healthcare provider before trying herbal or alternative therapies, especially if you are undergoing medical treatment.
6. Herbal Medicines
Herbal medicines are also the best form of natural remedies for achalasia. These medicines are made from the natural ingredients like herbs and extract from the plant sources. If you want to buy it you can explore our product page Herbal Remedies for Achalasia.
Achalasia vs GERD
Achalasia and GERD (Gastroesophageal Reflux Disease) share some overlapping symptoms but are fundamentally different conditions.
Key Differences
| Feature | Achalasia | GERD |
| Cause | Nerve damage affecting LES relaxation | Weak LES allowing acid reflux |
| Swallowing | Difficulty with solids and liquids | Usually solids first |
| Acid Reflux | Not primary issue | Primary symptom |
| Treatment | LES muscle disruption | Acid suppression (PPIs) |
GERD is caused by a weak LES, while Achalasia involves a LES that fails to relax. Misdiagnosis is common, so specialized testing is important.
Living With Achalasia
Achalasia is a chronic condition, but with appropriate treatment, most people lead normal, active lives.
Long-Term Monitoring
Patients may require periodic evaluations to:
- Monitor esophageal dilation
- Assess swallowing function
- Screen for rare complications such as esophageal cancer
Emotional and Psychological Impact
Chronic swallowing difficulty can cause anxiety around eating. Support groups and counseling may be helpful.
Practical Tips
- Sleep with the head elevated.
- Keep water nearby during meals.
- Plan meals carefully when traveling.
- Maintain regular follow-up with a gastroenterologist.
Outlook
With modern treatments such as POEM and laparoscopic surgery, symptom control rates exceed 80–90%. Early intervention significantly improves outcomes.
Conclusion
Achalasia is a rare but impactful esophageal disorder characterized by impaired swallowing due to nerve dysfunction. Although its exact cause remains unclear, early recognition and proper diagnosis are essential to prevent complications.
Treatment options—including pneumatic dilation, surgical myotomy, and POEM—offer highly effective symptom relief. While natural remedies and dietary adjustments cannot cure Achalasia, they can support overall digestive comfort and quality of life.
If you experience persistent difficulty swallowing both solids and liquids, unexplained regurgitation, or chest discomfort, consult a healthcare professional for evaluation. Early diagnosis and tailored treatment can dramatically improve long-term outcomes.
Understanding Achalasia empowers patients to seek timely care, make informed decisions, and live well despite this chronic condition.
