Achalasia: symptoms, diagnosis, treatment and cause

If there are problems with swallowing due to a muscle disorder of the esophagus, this is called achalasia. The food is then no longer transported properly through the esophagus. The food then piles up above the sphincter. The esophagus then swells, causing food to accumulate further. This causes the esophagus to become wider. Achalasia is rare, but can affect anyone. The disease mainly occurs in people between the ages of twenty and forty years old.


  • Problems swallowing
  • Pain in the chest
  • Rotten feeling behind the breastbone
  • Undigested food comes back up
  • Appetite decreases
  • Weight loss



Various tests are usually required to diagnose achalasia. Other causes must be excluded.


A gastroscopy is done to take a look inside the esophagus. This is done via a tube containing a camera that maps the esophagus and stomach. A gastroscopy can also show achalasia.

Swallow photo

To be sure that achalasia is present, a swallowing photo is often taken. The patient drinks a contrast agent. X-rays are taken when swallowing. In a person with achalasia, a dilated esophagus and decreased movement are seen.


Esophageal manometry clearly indicates achalasia in most cases. With manometry, a tube is inserted into the esophagus through the nose. A device on the tube measures the pressure in the esophagus and maps the mobility of the esophagus.


Achalasia cannot be cured. The treatment focuses on relieving the complaints. An attempt is also made to reduce the pressure on the sphincter muscle. There are different treatment methods. The doctor discusses with the patient which one is best.

Medication and botox

Medication is rarely used for achalasia. They can reduce symptoms slightly, but often cause many side effects. A common treatment for achalasia is injections of botulinum toxin (better known as Botox) into the sphincter muscle. This prevents food from accumulating there. The injections must be repeated often, because Botox only works for a few months. Furthermore, Botox is not suitable for years of treatment.


A doctor places a balloon into the esophagus through the mouth. Air enters near the sphincter. This treatment is performed again for three to four times. This treatment is successful in three quarters of patients. However, there is a risk of perforation of the sphincter.


Surgery is often used if pneumodilation does not work. A surgeon then cuts part of the sphincter. This causes the sphincter to lose its ability to squeeze, preventing it from retaining food. This treatment takes place via keyhole surgery under general anesthesia. A complication of a myotomy is that it may cause heartburn. The stomach contents then return from the stomach into the esophagus.


Achalasia is a dangerous disease. When the patient sleeps, there is a chance that food will end up in the lungs, causing pneumonia. Food that also accumulates in the esophagus can rot, resulting in all kinds of nasty infections. Furthermore, patients with achalasia have an increased risk of developing esophageal cancer. A patient with achalasia therefore remains under the supervision of a specialist after treatment.


Achalasia is caused by the absence of nerve cells in the wall of the esophagus. These nerve cells ensure that the sphincter muscle opens and closes easily. The nerve cells also ensure the mobility of the esophagus. If these nerve cells are missing, they cannot flow from the esophagus to the stomach. The food then accumulates in the esophagus. The nerve cells appear to disappear spontaneously. No cause has yet been found for this. Infections or an autoimmune disease may be the cause of achalasia.

How to eat with achalasia

Patients with achalasia often have to adapt their lifestyle to their disease. It is advisable to consult a dietician to prevent weight loss. If you have swallowing problems, it is important to choose food that is easy to swallow. Suitable types of meat include chicken and fish instead of beef. Vegetables and potatoes can be eaten pureed. Bread is easier to eat without crusts. It is also recommended not to eat large meals, but six smaller meals throughout the day instead of three large meals.

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