Achalasia: Swallowing Difficulties and How It's Diagnosed

Have you been finding it harder to swallow food or drinks, or noticed meals taking longer than before? Achalasia is a rare condition that affects the way your oesophagus moves food into your stomach, making swallowing more difficult over time. 

While the symptoms can feel frustrating, being familiar with the condition and how it is diagnosed can help you take the right steps towards relief. 

With the right medical guidance, you can find clarity about what is happening and begin working towards effective ways to manage your swallowing difficulties.

What Is Achalasia?

If you have been told you might have achalasia, understanding the condition can make a big difference in how you manage it. In simple terms, the meaning of achalasia refers to a rare disorder where the muscles in your oesophagus (the tube carrying food from your mouth to your stomach) have trouble moving food down. 

This happens because the lower oesophageal sphincter, a valve at the bottom, does not relax properly. As a result, swallowing can become harder over time. While achalasia is a chronic (long-term) condition, effective treatments are available to improve swallowing and reduce complications, though it cannot usually be cured completely.

Types Of Achalasia

Achalasia is not the same for everyone. Doctors classify it into different types based on how the oesophagus muscles work. Knowing your type helps define the best achalasia cardia treatment for you.

Here are the main types:

• Type I (Classic Achalasia): Minimal or no movement in the oesophagus muscles, making food passage very slow.
• Type II: The oesophagus squeezes food but in an uncoordinated way, often trapping it midway. This is the most common type.
• Type III (Spastic Achalasia): Intense, irregular muscle contractions cause chest discomfort and make swallowing more difficult.
• Secondary Achalasia (Pseudoachalasia): Mimics achalasia but is caused by other conditions, most often tumours at the gastro-oesophageal junction. It is not a true form of achalasia but an important mimic that doctors rule out.

Understanding which type you have allows you and your healthcare provider to choose treatment that gives the best chance of long-term relief.

Symptoms Of Achalasia

The signs of achalasia can build up slowly, sometimes making it hard to notice at first. Recognising them early can help you seek medical advice sooner. Common achalasia cardia symptoms include:

• Difficulty swallowing (dysphagia): Both solids and liquids may be affected.
• Regurgitation of food: Undigested food or saliva may come back up into your mouth.
• Chest discomfort or pain: Often after eating, due to food stuck in the oesophagus.
• Unintentional weight loss: Caused by difficulty eating enough.
• Heartburn-like sensation: Even without acid reflux.
• Frequent hiccups or throat irritation: Triggered by food remaining in the oesophagus.
• Coughing at night: Due to regurgitation while lying down.

If you notice these symptoms, it’s important to get checked so you can understand your condition and the treatment options available.

What Causes Achalasia?

The exact cause of achalasia is not fully understood, but it’s linked to damage in the nerves controlling your oesophagus muscles. These nerves usually help the lower oesophageal sphincter relax when you swallow. When they don’t work correctly, the sphincter stays tight, and food struggles to move into the stomach. 

Possible triggers may include immune system problems, viral infections, or, rarely, other medical conditions that affect nerve function. While the cause may not always be clear, knowing the achalasia meaning helps you focus on managing the condition effectively.

Risk Factors

While achalasia can happen to anyone, certain factors may increase your chances of developing it:

• Age: More common between 25–60 years old.
• Genetics: A family history of the condition may raise the risk.
• Autoimmune conditions: Your immune system mistakenly attacking healthy cells may contribute.
• Previous viral infections: Some infections may damage the oesophagus nerves.
• Other nerve-related disorders: Conditions affecting the nervous system can sometimes be linked.

Even if you have one or more of these risk factors, it does not mean you will definitely develop achalasia. Understanding your risk simply means you can pay closer attention to early signs and seek advice sooner.

What Are The Complications Of Achalasia?

Without treatment, achalasia can sometimes lead to other health issues. These are usually due to ongoing swallowing problems and food staying in the oesophagus:

• Oesophageal dilation: The oesophagus may stretch over time, making swallowing harder.
• Aspiration pneumonia: Food or liquid entering the lungs can cause infection.
• Severe weight loss or malnutrition: From not getting enough food down.
• Oesophagitis: Inflammation caused by food build-up.
• Increased risk of oesophageal cancer: People with long-standing untreated achalasia have a higher risk of oesophageal squamous cell carcinoma, though the overall risk remains low.

These complications can be reduced or avoided with timely diagnosis and the right achalasia cardia treatment.

Diagnosis & Test

Diagnosing achalasia involves tests to confirm how your oesophagus is working. Common Tests for Achalasia include:

Treatment

Treatment of achalasia focuses on improving swallowing, easing discomfort, and preventing complications. Your options will depend on your type of achalasia, your health, and preferences. Common approaches include:

Nonsurgical Treatment

If surgery is not the first choice, you may be offered:

• Pneumatic dilation: A balloon is inserted and inflated to stretch the lower oesophageal sphincter.
• Botulinum toxin (Botox) injection: Temporarily relaxes the sphincter muscle.
• Medication: Nitrates or calcium channel blockers may help relax the sphincter, but they are often less effective and used only when other options are unsuitable.
• Lifestyle changes: Eating softer foods, chewing well, and avoiding lying down soon after meals.

These options can be effective for some people, especially when symptoms are milder or surgery is not suitable.

Surgery

Surgical treatment is often recommended for longer-term relief:

• Heller myotomy: Cutting the sphincter muscle to allow food to pass more easily.
• Peroral endoscopic myotomy (POEM): A less invasive approach done through an endoscope.
• Fundoplication: Often performed alongside Heller myotomy to reduce reflux, but not usually needed after POEM.

Your surgeon will help you understand which procedure offers the best balance of benefits and recovery time.

Treatment Complications

While treatment is generally safe, possible issues include:

• Acid reflux: More common after surgery.
• Oesophageal perforation: Rare but possible during dilation or surgery.
• Need for repeat procedures: Some treatments may not be permanent.
• Temporary swallowing discomfort: Often improves as you recover.

With proper medical care and follow-up, most treatment-related problems can be managed effectively.

Living With Achalasia

Living with achalasia means adjusting your eating habits and staying aware of changes in your symptoms. Regular follow-ups with your healthcare team help track your progress and adjust treatment if needed.

You may find it helpful to eat slowly, choose softer foods, and stay upright for at least 30 minutes after meals. With these habits and ongoing care, many people manage their condition well and maintain a good quality of life.

Is There An Achalasia Diet?

There is no single diet that cures achalasia, but certain foods can make swallowing easier. Soft, moist meals, well-cooked vegetables, soups, and smoothies can help food pass more smoothly. Avoiding dry or very tough foods may reduce discomfort.

Drinking water during and after meals can help wash food down. Some people find eating smaller, more frequent meals works better than large portions. These adjustments can support your achalasia cardia treatment and help you feel more comfortable at mealtimes.

Is Achalasia Deadly?

Achalasia itself is not life-threatening, especially with treatment. However, without treatment, it can cause malnutrition, aspiration, and increase cancer risk over decades

However, untreated achalasia over many years can lead to serious complications, which is why recognising symptoms and seeking timely care is important. Understanding the meaning of achalasia and working with your healthcare team can help you manage the condition and reduce long-term risks.

Conclusion

Early detection and accurate diagnosis are key to managing achalasia effectively and improving your quality of life. Timely medical evaluation helps guide the best treatment for your needs. 

For reliable and precise diagnostic testing, consider Metropolis Healthcare, a trusted name with advanced facilities and expert pathologists dedicated to delivering accurate results for better health decisions.