Answers
What is achalasia, and how is it treated?
Short answer
Achalasia is an uncommon condition in which the muscle at the lower end of the food pipe does not relax, and the food pipe loses its normal squeezing movement. Food and liquids collect in the food pipe, causing difficulty swallowing, regurgitation, chest pain and weight loss. Treatment opens the tight muscle and relieves symptoms well.
Symptoms
- Difficulty swallowing both solids and liquids, which slowly gets worse
- Undigested food coming back up, especially when lying down
- Chest pain or heartburn that does not improve with acidity tablets
- Coughing at night, and weight loss
Tests
- Upper endoscopy, to rule out other causes such as a narrowing or a growth
- Barium swallow X-ray, which shows a widened food pipe narrowing like a bird's beak at the lower end
- Oesophageal manometry, which measures the pressure and movement of the food pipe muscles and confirms the type of achalasia
Treatment
The choice depends on age, overall health, the type of achalasia and local expertise. Medicines alone usually do not work well.
- Balloon dilatation: a large balloon passed through the scope stretches the tight muscle; it can be repeated if symptoms return
- Surgery (Heller myotomy): the tight muscle is cut by keyhole surgery, usually with an anti-reflux step
- An endoscopic muscle-cutting procedure is also available at specialised centres
- Botulinum toxin injection gives short-term relief for people who cannot have other treatments
Living with achalasia
Eat slowly, chew well, drink water with meals and sit upright for a while after eating. Raise the head end of the bed. Long-standing achalasia needs regular follow-up, as the food pipe can widen and the risk of complications rises.
Eating with achalasia
Eat more
- Soft, moist foods: dal, khichdi, curd rice, well-cooked vegetables, soups
- Small bites, chewed well, with sips of warm water between bites
- An early dinner, at least 3 hours before lying down
Cut down
- Dry, sticky or chunky food: dry roti, bread, rice without dal, large pieces of meat
- Eating in a hurry or while lying back
- Large meals late at night
Good to know
- Sitting upright and walking a little after meals helps food pass.
- After dilatation or surgery, start with liquids and soft food as advised, then return to normal food.
Common questions
Is achalasia a type of cancer?
No. But long-standing achalasia slightly raises the risk of food pipe cancer, so regular follow-up is advised.
Can achalasia be cured?
Treatment relieves swallowing very well in most people, but it does not restore normal food pipe movement, so symptoms can return and need repeat treatment.
Will I need treatment again after balloon dilatation?
Some people do, after months or years. The balloon can be repeated, or surgery considered.