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JAMA Patient Page
May 12, 2015


JAMA. 2015;313(18):1876. doi:10.1001/jama.2015.3407

Achalasia is a disease that can make it hard to swallow. It can also mimic other common disorders, like gastroesophageal reflux disease (GERD).

What Causes Achalasia?

Achalasia is caused by a problem in the esophagus (the tube between the throat and the stomach). This problem is caused by a loss of nerves. Doctors do not know for sure why the nerves are lost. But the result is that muscles in the esophagus do not work properly. When these muscles do not work properly, food cannot pass into the stomach. An article in the May 12, 2015, issue of JAMA provides more information.

What Are the Symptoms?

  • Trouble swallowing liquids and solids

  • Chest pain or heartburn

  • Food backing up into your mouth or throat (may be worse at night)

  • Cough or choking on fluid or food

These symptoms are like those of GERD, which is more common. Many patients with these symptoms are treated for GERD first.

What Makes the Symptoms Worse?

  • Certain foods, such as meats, bread, rice, and certain vegetables. Your doctor or a dietitian can help you choose foods.

  • Drinking water or carbonated drinks with meals. Some people find this helps. But others find this makes symptoms worse (especially chest pain)

  • Eating too close to bedtime. You should not eat within 4 hours of going to bed. If possible, you should also raise the head of your bed a few inches. This can keep swallowed food from coming back up.

  • Medications trapped in the esophagus. Many medications taken by mouth can cause problems. But some cause more symptoms than others. Talk to your doctor.

What Can Be Done?

Your doctor can diagnose achalasia by ordering a few tests. Some tests help the doctor see inside your esophagus using a camera or x-rays. Another test gives information about the muscles in your esophagus. There is no cure for achalasia. But there are effective treatments to help your symptoms. Treatments may be medical or surgical.

  • Medical treatments use medicines to treat achalasia. Medical treatments might be used if you are not able to have surgery. These treatments might also be used to provide temporary relief of your symptoms.

    • Some medicines help the muscles in the esophagus to work properly. But these medicines might not work well to help your symptoms. More important, these medicines do not keep your achalasia from getting worse. You should only use them for a short time.

    • The doctor can use a camera to inject a medicine into your esophagus. This medicine can help your symptoms by relieving pressure that causes blockage. But this treatment might only last 6 months to a year. You would need to be treated every year.

  • Definitive treatments sometimes involve surgery. Definitive treatments give better relief and are used when possible. These treatments include

    • Pneumatic dilation. In this treatment, the doctor uses a camera to place a small balloon in your esophagus. The balloon is then used to stretch the muscles in the esophagus. This treatment is often effective. But you might need several treatments for best results.

    • Laparoscopic Heller myotomy. In this treatment, the doctor uses surgery to help the blockage in your esophagus. The doctor might also perform other surgery to keep swallowed food from coming back up. Almost all patients find that this treatment helps. But it poses more risk than using a balloon.

    • Per-oral esophageal myotomy (POEM). This treatment also uses surgery to help the blockage in your esophagus. But the doctor performs this surgery from inside the esophagus, using a camera. Almost all patients find that this treatment helps. But you might need several treatments.

What Can I Expect?

  • You should be able to eat with fewer symptoms. But you will need to watch what you eat to avoid problems.

  • Achalasia is a long-term disease. You will need to keep seeing your doctor to make sure the disease does not get worse.

  • Complications are possible. Tell your doctor if your symptoms get worse or if you lose weight without trying to.

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The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
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Article Information

Conflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Pandolfino reported receiving consulting and speaking fees from Given Imaging/Covidien and Sandhill Scientific. Dr Gawron reported no disclosures.

Source: Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. doi:10.1001/jama.2015.2996.

Topic: Gastroenterology