Achalasia Symptoms, Causes, and Treatment

Achalasia Overview

Tampa General Hospital’s Digestive Diseases Institute treats a wide range of gastrointestinal disorders, including achalasia, which makes it difficult for foods and beverages to pass from the esophagus into the stomach. Achalasia is very rare, affecting about 1 in every 10,000 people.

Causes and Risk Factors of Achalasia

Researchers have yet to determine exactly what causes achalasia, but studies suggest that it may result from damage to nerves within the esophagus, possibly due to an autoimmune response triggered by a viral infection. This nerve damage gradually paralyzes the esophagus and prevents the lower esophageal sphincter from opening, keeping foods and beverages from entering the stomach. In rare cases, achalasia is caused by an inherited genetic disorder.

Signs and Symptoms of Achalasia

Because achalasia prevents foods and beverages from passing into your stomach, it can cause them to build up within your esophagus, where they may begin to ferment. They can then be regurgitated into your mouth, producing a bitter taste. Other achalasia symptoms may include:

  • Difficulty swallowing
  • A feeling of having something stuck in your throat
  • Burping
  • Hiccups
  • Heartburn (a burning sensation within the chest)
  • Intermittent chest pain
  • Coughing (especially at night)
  • Vomiting
  • Unexplained weight loss

Achalasia is a progressive condition, so these symptoms tend to gradually appear and worsen over time. It’s important to seek treatment to avoid potential complications. For example, if food is aspirated into the lungs, it could lead to pneumonia.

Diagnosing Achalasia

Achalasia diagnosis typically begins with a physical examination and a discussion of the patient’s medical history and symptoms. If your doctor thinks you might have achalasia, they’ll likely order one or more of the following tests to confirm their diagnosis:

  • Esophageal manometry
  • Upper endoscopy
  • X-ray

Achalasia Treatment

While there’s currently no cure for achalasia, certain treatments can help manage symptoms by widening the lower esophageal sphincter. One of these treatments is pneumatic dilation, a nonsurgical procedure that involves endoscopically inserting a balloon into the center of the lower esophageal sphincter and then inflating it to open the muscle.

In some cases, doctors may recommend either a Heller myotomy or a peroral endoscopic myotomy (POEM). Both of these surgeries involve cutting the muscle at the bottom of the lower esophageal sphincter. Because they can increase the chances of subsequently developing gastroesophageal reflux disease (GERD), the surgeon may also wrap the top of the stomach around the sphincter to prevent stomach acid from flowing into the esophagus (a procedure known as fundoplication).

Achalasia can also be treated conservatively by taking muscle relaxers or receiving BOTOX® injections. However, doctors generally only recommend these treatments for patients who aren’t good candidates for pneumatic dilation or surgery. As a last resort, doctors may recommend removing the esophagus entirely.

TGH’s Approach to Treating Achalasia

If you’re concerned that you might have achalasia, it’s important that you entrust your care to highly experienced, compassionate providers. That’s exactly what you can expect to find at Tampa General Hospital’s Digestive Diseases Institute. Our multidisciplinary team of surgeons, gastroenterologists, radiologists, medical oncologists and pharmacotherapists work together to supply patients with highly individualized care, all from a single location in Tampa, FL.

We’re proud to operate a GERD and Esophageal Surgery Center, which offers tertiary and quaternary esophageal care, as well as the Joy McCann Culverhouse Center for Swallowing Disorders, a national and international referral center for the most complex swallowing disorders and one of the country’s few endowed swallowing centers. It’s qualities like these that led U.S. News & World Report to name TGH one of the best hospitals for Gastroenterology and GI Surgery for 2023-24.

Contact Tampa General Hospital at (800) 822-3627 to schedule an appointment with one of the achalasia experts at our Digestive Diseases Institute.