Achalasia

Overview

Achalasia is a rare disorder in which the esophagus loses its ability to move food toward the stomach, and the lower esophageal sphincter (LES) fails to relax properly. This leads to difficulty swallowing, regurgitation, chest discomfort, and progressive esophageal dilation. Achalasia is a chronic condition that requires specialized evaluation and treatment.

Causes

The exact cause of achalasia is unknown. It is believed to result from degeneration of the esophageal nerve cells responsible for coordinated muscle contractions. Possible contributors include autoimmune factors, viral triggers, and genetic predisposition.

Risk Factor

Risk factors include a family history of achalasia, autoimmune disorders, and certain viral infections. Although rare, achalasia can occur at any age but is most common in adults between 25 and 60.

How Achalasia Affects the Body

Achalasia prevents the LES from relaxing and disrupts normal esophageal motility. Food becomes trapped in the esophagus, leading to dilation, inflammation, regurgitation, aspiration, and weight loss. Over time, the esophagus may become severely enlarged.

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Complications

Complications include aspiration pneumonia, esophagitis, malnutrition, significant weight loss, and an increased long‑term risk of esophageal cancer. Severe cases may lead to megaesophagus.

Symptoms & Signs

Common symptoms include difficulty swallowing solids and liquids, regurgitation of undigested food, chest pain, heartburn‑like sensations, coughing at night, and unintentional weight loss.

Diagnosis

Diagnosis is made through esophageal manometry (gold standard), barium swallow studies, and endoscopy. Manometry confirms impaired LES relaxation and absent peristalsis.

Differential Diagnosis

Diagnosis is made through esophageal manometry (gold standard), barium swallow studies, and endoscopy. Manometry confirms impaired LES relaxation and absent peristalsis.

Lifestyle Modifications

Lifestyle adjustments include eating slowly, drinking water with meals, avoiding late‑night eating, elevating the head of the bed, and choosing softer foods to reduce symptoms.

Treatment Options

Treatment focuses on relieving LES pressure and improving esophageal emptying. Options include pneumatic dilation, Heller myotomy, POEM (peroral endoscopic myotomy), Botox injections, and medications. POEM and Heller myotomy offer the most durable results.

When to See a Doctor

Seek medical evaluation if you experience progressive difficulty swallowing, regurgitation, chest pain, weight loss, or nighttime coughing.

When to Seek Treatment

Treatment is recommended when symptoms interfere with eating, cause weight loss, or lead to aspiration. Early intervention prevents long‑term esophageal damage.

Long-Term Outlook

Achalasia is chronic but manageable. Long‑term follow‑up is important to monitor for recurrence, esophageal dilation, or rare complications such as cancer.

Prognsis

With appropriate treatment, most patients experience significant symptom improvement. POEM and Heller myotomy provide excellent long‑term outcomes.

Why Choose Dr. de la Cruz-Muñoz

Dr. Nestor de la Cruz‑Muñoz provides expert evaluation and advanced treatment options for achalasia, including minimally invasive surgical and endoscopic therapies. Patients receive comprehensive care focused on long‑term relief and improved quality of life.