What is Achalasia?

Achalasia is an uncommon swallowing disorder which affects about 1 in every 100,000 people. The term means ‘failure to relax’ as a muscle at the lower end of the oesophagus (food pipe) experiences a nerve spasm and is unable to open and let food pass into the stomach. This results in food sticking the oesophagus once swallowed and can be uncomfortable and even dangerous.

The most common symptoms of achalasia are difficulty in swallowing and regurgitation/vomiting of food and/or drink. Some patients suffer from extreme chest pain when eating or uncomfortable coughing fits. In extreme cases it can lead to breathing problems as the food from the food pipe may end up in the throat or lungs when regurgitated.

Many patients identify ‘trigger foods’ and eliminate them from their diet to manage symptoms or change their lifestyle to cope. Some patient’s disease can suddenly worsen and make eating anything – even water – impossible. You can read some achalasia patient experiences here.

There is no known cause of achalasia, but some doctors theorise there could be a genetic link or it is triggered by an infection or that it could be a type of autoimmune disease.

Achalasia testing

Achalasia is diagnosed in several ways. A barium swallow is recommended when achalasia is suspected and involves and X-ray study (taking videos of the oesophagus) after barium is swallowed. The barium fills the oesophagus and as it passes into the stomach it can be watched. Patients with achalasia will show the oesophagus as widened but tapers to narrower at the lower end and the barium will also take longer than average to pass into the stomach (instead ‘sitting’ in the oesophagus).

Patients will also have a test called oesophageal manometry, which can detect abnormalities in the muscle function of the oesophagus (characteristic of achalasia). The test takes less than 15 minutes and involves passing a thin tube with pressure sensors down the back of the nose and into the food pipe. Patients are then asked to swallow liquids and solids while the sensors measure the pressure generated in the oesophagus to propel food and drink into the stomach. In achalasia, various different pressure points will be either absent or enhanced when swallowing and these readings help the gastroenterologist to tailor treatment

Endoscopies can also be used to examine and diagnose achalasia, as this type of procedure provides direct visualisation of the oesophagus.

Treating achalasia

Patients with achalasia often manage their symptoms with lifestyle medications (such as avoiding food before bedtime or cutting out ‘trigger’ foods) and some doctors prescribe oral medication (nitrates and calcium-channel blockers) but these treatments alone are often not enough to manage the disease as they do not address the underlying issue with the oesophagus’ structure.

Treating the lower oesophageal sphincter directly is popular as it can instantly relieve the nerve spasms. There are two forms of treatment currently used on the NHS:

Balloon dilation
A specialist doctor, such as a Gastroenterologist, uses endoscopy (camera down the throat) to position a special balloon across the sphincter that is tight in achalasia (to help it to stretch and dilate the muscle) making it more open and work more effectively. Often patients will require two of these procedures a few weeks apart with a smaller balloon followed by a bigger balloon to help swallowing. This ~80% successful in improving swallowing

Botox injections
Performed via endoscopy, botulinum toxin (Botox) is injected into the sphincter to help loosen the muscle. This is used very infrequently now as it often does not work or needs to be repeated every 3-6 months

Heller myotomy
A surgeon cuts the muscle at the end of the oesophagus and top of the stomach. It is performed via an incision on the patient’s abdomen and has a high rate of success (> 90% of patients will have improved swallowing)

A newer and far more effective treatment is to use the endoscope to create a tunnel in the layers of the oesophagus and to cut the muscles away that way – this is a minimally invasive procedure called POEM. It does not need surgery and is very safe, but unfortunately is not available on the NHS yet.


Per-oral endoscopic myotomy (POEM) is a new and permanent minimally invasive endoscopic solution for achalasia. The procedure does not need to be repeated and in >90% of cases complete symptom resolution is achieved. POEM is performed via endoscope which means no scars on the abdomen and a lower risk of complications than traditional myotomy surgery. The procedure takes less than 45 minutes and patients can expect to be discharged 24 hours after the procedure and describe it as a life changing experience. Read about POEM patient experiences in our patient hub.

Dr Rehan Haidry is an experienced Consultant Gastroenterologist who can help talk through your options as someone living with achalasia or diagnose the condition should you be experiencing symptoms you’re worried about.

Get In Touch

For any enquiries about conditions, tests or treatments, please feel free to call Dr Rehan Haidry’s medical secretary Debra Hyams on:

Tel: 0203 423 7609  |  Email: