Achalasia and esophageal motility disorders

The esophagus is a hollow and muscular tube that carries food and liquids from your mouth to your stomach. If the muscles in your esophagus do not contract (tighten) properly, it will be more difficult for food and liquids to reach your stomach. This condition is known as esophageal motility disorders. Esophageal motility disorders make it harder for you to swallow, make food go back to your mouth, and sometimes cause chest pain.

One type of esophageal motility disorder is achalasia.


Achalasia occurs when there is degeneration of the nerves of the esophagus.


As a result, the muscles in the esophagus stop working (there is no peristalsis), and the valve at the bottom of the esophagus does not open. It is believed that this problem affects between 1 and 2 people per 100,000, with about 3,000 new cases diagnosed each year in the United States.

Other less common motility disorders include spastic motor disorder of the esophagus (nutcracker esophagus and diffuse esophageal spasm), inefficient esophageal motility disorder, and secondary esophageal motility disorders that are related to other medical conditions such as scleroderma, diabetes, and alcohol consumption.

Although achalasia may be caused by a parasite in South America (Chagas disease), in most patients in the United States there is no cause for achalasia. Some researchers think it could be related to a virus.

Recent studies have indicated that achalasia could be caused by an immune system disorder in which the patient’s own immune system attacks the nervous system within the muscles of the esophagus, causing them to malfunction.

Achalasia does not affect any particular race or ethnic group, and is not inherited from the family. Esophageal motility disorders develop slowly and get worse over time. If you have only a brief episode of symptoms, you probably do not have an esophageal motility disorder.

Patients with achalasia are sometimes initially treated as if they had gastroesophageal reflux disease (GERD), but after doing additional tests they are diagnosed with achalasia.

The symptoms of achalasia include:

Difficulty to swallow
Pressure in the chest after eating
Undigested liquids and foods that return to the mouth (regurgitation), sometimes hours after eating
Cough or drowning with food
Bad breath
Symptoms may get worse with certain foods (such as meat, bread and rice), certain liquids (such as carbonated drinks), and if you eat a short time before going to sleep.

If you are having problems continuously when you eat or drink liquids, you can print these sample questions to use when talking with your doctor.

If left untreated, achalasia can cause considerable weight loss, lung infections, and pneumonia.
Tests used to diagnose acalacia include high resolution esophageal manometry, esophagogram (barium swallowing) and endoscopy.

Esophagogram with barium demonstrating a marked dismotility Esophagogram with barium demonstrating a marked dismotility

For more information on these tests, visit our page on common diagnostic tests.

There is no cure for achalasia, but once you have been diagnosed with the condition, several medications and surgical procedures (performed by a cardiothoracic surgeon) may help treat the symptoms.

The different treatment options are described below.

Esophageal Dilation
A balloon or rubber dilator is used with esophagoscopy to stretch the muscles of the lower esophageal sphincter. There is a small risk of tearing or rupturing the esophagus which could requi …

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Botulinum toxin can be injected with esophagoscopy to relax the lower esophageal sphincter for 1-2 months. This becomes less effective over time and repeat injections can cause scarring maki …

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Heller myotomy
A myotomy is most frequently performed using minimally invasive techniques (laparoscopic or robotic) using five small incisions although it can also be performed through an open incision in …

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Per-oral Esophageal Myotomy (POEM)
Using esophagoscopy, a hole is made from the inside of the esophagus creating a tunnel to divide the esophageal and stomach muscles. The hole is sealed with a clip or suture at the end of th …

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HD3D manometry showing the lower esophageal sphincter before and after oral endoscopic myotomy
If you have end-sta

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