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Achalasia

Achalasia is an uncommon condition in which the muscular body of the esophagus does not contract normally or at all. The muscular valve mechanism at the end of the esophagus also fails to relax, which creates a barrier to food and liquid entering the stomach.  Over time, the body of the esophagus becomes stretched out and dilated, acting like a reservoir, and large volumes of food and liquid can accumulate.  Often, patients think they have reflux or are misdiagnosed with reflux. 

The most common symptom is difficulty swallowing, but patients will often describe a sensation of swallowed food, or even an entire meal, being stuck in the chest for a period of time.  Weight loss and chest pain with and after meals can also occur.  It is possible to regurgitate food and liquid that never enters the stomach, and because of this, patients who have achalasia are at great risk for aspiration and pneumonia.

A barium swallow is helpful to make a diagnosis, because an esophagus with achalasia typically has very characteristic features, but the diagnosis is only made for certain with a pressure measuring test (esophageal manometry).  Endoscopy is helpful too, and sometimes procedures can be done at the time of endoscopy to temporarily or more permanently relieve difficulty swallowing.

There is no “cure” for achalasia, there are several options for treatment, and patients generally will find great relief of their symptoms with at least one of those options.  There are endoscopic treatments available as well as surgery.  It is important to have a discussion as to what all of your treatment options are, so that you and your physician pursue the one that is most right for you.