The comprehensive guide : Achalasia

Achalasia : Question and Answer


Achalasia is a rare and debilitating medical condition that affects the esophagus, causing difficulty in swallowing and a range of uncomfortable symptoms. This disorder, characterized by the inability of the lower esophageal sphincter (LES) to relax properly, leads to the narrowing of the esophagus and an accumulation of food and liquids. In this comprehensive article, we will explore the seriousness of achalasia, its prevalence, the specialists who treat it, the preferred treatment options, and the essential post-treatment follow-up required to manage this challenging condition.

Is Achalasia Serious?

Achalasia may be rare, but it is undoubtedly a serious medical condition that can significantly impact an individual's quality of life. The primary issue in achalasia is the dysfunction of the LES, which normally relaxes to allow food and liquids to pass from the esophagus into the stomach. When this process is disrupted, several distressing symptoms can arise, including:

  • 1. Dysphagia: The hallmark symptom of achalasia is difficulty swallowing, especially with solids and, eventually, liquids. This can lead to malnutrition and weight loss.

  • 2. Regurgitation: Incomplete emptying of the esophagus can result in the backflow of undigested food and fluids, causing discomfort and increasing the risk of aspiration pneumonia.

  • 3. Chest Pain: Patients with achalasia often experience chest pain or discomfort, which can mimic heart-related issues and cause further anxiety.

  • 4. Heartburn: While heartburn is more commonly associated with gastroesophageal reflux disease (GERD), some achalasia patients may experience it as well due to the LES malfunction.

  • 5. Respiratory Issues: Chronic aspiration of food and liquids can lead to respiratory problems and lung infections.

Untreated achalasia can lead to serious complications, including weight loss, malnutrition, and the development of esophageal cancer in rare cases. Therefore, it is crucial to seek medical attention if you suspect you have achalasia or are experiencing any of the symptoms mentioned.

How Common is Achalasia?

Achalasia is considered a rare disorder, with an estimated prevalence of 1 in 100,000 individuals. Although it can occur at any age, it is most commonly diagnosed in people between the ages of 25 and 60. It affects both men and women equally, with no significant gender predisposition.

While achalasia is relatively uncommon, it's essential to understand that early diagnosis and treatment can significantly improve a patient's quality of life and prevent complications. Therefore, awareness of achalasia and its symptoms is crucial for timely intervention.

Who Are the Doctors Who Treat Achalasia?

The management of achalasia typically involves a multidisciplinary approach, with several medical professionals playing vital roles in the diagnosis, treatment, and ongoing care of patients.

  • 1. Gastroenterologists: These physicians specialize in the diagnosis and treatment of digestive disorders. Gastroenterologists are usually the first point of contact for patients with achalasia. They perform diagnostic tests such as esophagoscopy, manometry, and barium swallow studies to confirm the diagnosis.

  • 2. Thoracic Surgeons: In many cases, surgical intervention is required to treat achalasia effectively. Thoracic surgeons are experts in performing procedures such as laparoscopic Heller myotomy, which involves cutting the LES muscle to relieve the obstruction.

  • 3. Interventional Radiologists: In some instances, balloon dilation of the LES can be attempted to widen the narrowed esophagus. Interventional radiologists may be involved in this procedure.

  • 4. Dietitians and Nutritionists: Due to the risk of malnutrition and weight loss associated with achalasia, dietitians and nutritionists play a critical role in developing specialized diets and nutrition plans for patients.

  • 5. Psychologists and Support Groups: The emotional toll of living with a chronic condition like achalasia should not be underestimated. Psychologists and support groups can help patients cope with the psychological and emotional challenges associated with the disease.

What is the Drug of Choice for Achalasia?

The treatment of achalasia primarily focuses on relieving the obstruction at the LES to improve swallowing and reduce symptoms. While there is no cure for achalasia, several treatment options are available, and the choice of treatment depends on various factors, including the patient's overall health and the severity of the condition.

  • 1. Medications: Medications may be used to help relax the LES and alleviate symptoms temporarily. Calcium channel blockers and nitrates are the most commonly prescribed drugs for this purpose. However, these medications are often considered a short-term solution and may not provide long-lasting relief.

  • 2. Botulinum Toxin (Botox) Injection: In some cases, botulinum toxin injections can be administered directly into the LES during an endoscopic procedure. This can provide temporary relief by relaxing the muscle, but the effects typically last for only a few months and may require repeated injections.

  • 3. Balloon Dilation (Pneumatic Dilation): This minimally invasive procedure involves inflating a balloon inside the LES to stretch and disrupt the muscle fibers, allowing for better food passage. Balloon dilation can be effective but may require repeat procedures in some cases.

  • 4. Surgical Myotomy: Laparoscopic Heller myotomy is the surgical procedure of choice for achalasia. During this operation, the surgeon cuts the LES muscle to permanently relieve the obstruction. This surgery is highly effective in improving swallowing and reducing symptoms.

The choice of treatment depends on individual circumstances, and patients should discuss the options with their healthcare providers to determine the most suitable approach.

What Post-Treatment Follow-Up is Needed?

After undergoing treatment for achalasia, patients require diligent post-treatment follow-up to monitor their progress and manage any potential complications. Here are some essential aspects of post-treatment care:

  • 1. Dietary Modifications: Patients may need to make long-term dietary adjustments to accommodate their improved swallowing function. Working closely with a dietitian or nutritionist can help maintain proper nutrition and prevent weight loss.

  • 2. Regular Check-Ups: Follow-up appointments with the treating physician, gastroenterologist, or surgeon are essential to assess the effectiveness of the treatment and monitor for any recurrence of symptoms.

  • 3. Lifestyle Changes: Certain lifestyle changes, such as eating slowly, avoiding large meals, and refraining from lying down immediately after eating, can help manage symptoms post-treatment.

  • 4. Monitoring for Complications: Regular surveillance to detect any potential complications, such as gastroesophageal reflux disease (GERD) or recurrent dysphagia, is vital. Medications or additional interventions may be required to address these issues.

  • 5. Emotional Support: The psychological impact of living with a chronic condition like achalasia should not be underestimated. Patients may benefit from counseling or support groups to help cope with the emotional challenges associated with the disease.


Achalasia is a rare but serious medical condition that affects the esophagus and can have a significant impact on a person's quality of life. Timely diagnosis and appropriate treatment are crucial for managing the disorder effectively and preventing complications. While achalasia is not curable, various treatment options, including medications, endoscopic procedures, and surgery, can help improve swallowing and reduce symptoms. Following treatment, patients require ongoing care, dietary adjustments, and regular check-ups to maintain their health and well-being. With the right medical team and support, individuals with achalasia can lead fulfilling lives and manage this challenging condition successfully.

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