What Is Achalasia?

It often starts quietly. A bite of bread seems to pause halfway down. A sip of water helps — mostly. Months later, meals take longer, eating out feels like a negotiation, and food sometimes comes back up undigested. That slow, creeping difficulty with swallowing is the hallmark of achalasia, an uncommon disorder of the esophagus — the muscular tube that carries food from your mouth to your stomach.

The video at the top of this page, "Esophagomyotomy for Achalasia," is a short recording (about two minutes) of one of the operations used to treat the condition. It is worth watching once you have read what the condition actually is, because the operation only makes sense when you understand the problem it is solving.

What you may notice first

Swallowing works in two moves. Muscles in the esophageal wall squeeze in a coordinated wave — peristalsis — that pushes food downward, and a ring of muscle at the bottom, the lower esophageal sphincter, relaxes at just the right moment to let the food through into the stomach. In achalasia, both moves fail: the wave weakens or disappears, and the sphincter stays tight instead of opening.

Because of that, what you'd expect to feel is trouble with both solids and liquids — unlike a simple narrowing, which usually troubles solids first. People describe food sticking in the chest, needing to drink with every bite, regurgitating food that never really made it down, and sometimes chest discomfort or slow weight loss. Symptoms build gradually, often over years, which is why many people adapt their eating for a long time before anyone names the cause. Our longer video, "Swallowing Disorders and Achalasia" (just over six minutes), walks through that picture in more detail.

What to expect at the assessment

If swallowing difficulty is slowly getting worse, expect your clinician to want tests rather than guesses — partly because several conditions can feel similar. Reflux disease is the commonest look-alike, and our guide to acid reflux (GERD) covers how it differs.

The tests you may be offered each answer a different question. An endoscopy lets the clinician look inside the esophagus and stomach directly and rule out other causes. A barium swallow — an X-ray taken while you drink a contrast liquid — shows the shape of the esophagus and how well it empties. The test that confirms achalasia is esophageal manometry, in which a thin tube measures the pressures of those swallowing muscles and shows whether the wave is missing and the sphincter is failing to relax. If your main symptom is difficulty swallowing more broadly, our guide to dysphagia (difficulty swallowing) explains how that symptom is approached.

What treatment tries to do

Here's the honest framing: treatment for achalasia doesn't restore the lost muscle wave. What it does is loosen or open the tight sphincter at the bottom of the esophagus, so gravity and the pressure of swallowing can move food into the stomach more easily. That single goal explains every option your specialist may discuss.

The choices differ in how they reach that goal. Some widen the sphincter from inside, using a balloon passed through an endoscope to stretch it open. Others work on the muscle itself: the operation in the video above — an esophagomyotomy — divides the tight muscle fibres from outside so the passage relaxes, and a related approach reaches the same muscle from inside with an endoscope. Medicines that relax the sphincter exist too, though their effect tends to be weaker and shorter-lived, so they're usually reserved for people who aren't candidates for a procedure.

Which option suits you depends on the exact pattern the manometry shows, your overall health, and your own preference after the trade-offs are explained — including the chance that loosening the sphincter lets stomach acid wash back upward afterwards. Expect that conversation to be unhurried, and expect follow-up: swallowing is usually much improved, but the esophagus still needs watching over time.

Living with it in the meantime

While you're waiting for assessment or treatment, small habits make eating easier and safer: take smaller bites, chew thoroughly, eat slowly, and stay upright for a while after meals rather than lying flat. Soft foods and drinks alongside food help many people. None of this treats the underlying problem, though — progressive difficulty swallowing always deserves a proper assessment, especially if you're losing weight or food is regularly coming back up.

So if meals have slowly become hard work, achalasia is one of the explanations a specialist will consider: a swallowing tube whose wave has failed and whose exit valve won't open. It can be confirmed with the right tests, and while treatment can't rebuild the wave, opening that valve can make eating feel ordinary again.

Frequently Asked Questions

Is achalasia the same as acid reflux?
No, though they can feel similar and are often confused. In reflux, the sphincter at the bottom of the esophagus is too loose and lets acid wash upward. In achalasia, that sphincter is too tight and fails to relax, and the swallowing wave above it is lost. The tests described above tell the two apart.

Does achalasia get worse over time?
It usually progresses slowly. Food and liquid empty from the esophagus less well as the muscle function is lost, which is why symptoms tend to build over months to years rather than appearing overnight.

Can achalasia be cured?
Treatment doesn't restore the lost swallowing wave, so it isn't a cure in that sense. What treatment does — widening or dividing the tight sphincter — can improve swallowing a great deal, and many people eat comfortably again, with follow-up to keep an eye on things.

When should difficulty swallowing be checked promptly?
Progressive difficulty swallowing should always be assessed, and sooner if you're losing weight, food regularly comes back up, or swallowing is getting worse over weeks rather than years. Those features need a clinician to look for the cause directly.

MedicalVideos.com has published trusted medical videos since 2007. The site was founded by Dr. Mohamed Ibrahim, MD, PhD — physician-scientist.

Educational only — this article is general information about achalasia, not medical advice and not a diagnosis. If swallowing is becoming difficult or you are losing weight, seek medical care promptly and discuss your symptoms with your own doctor.