Overview
Achalasia is a rare but serious esophageal motility disorder in which the lower esophageal sphincter (LES) fails to relax during swallowing and the esophagus loses its co-ordinated peristaltic contractions. Food and liquid accumulate in the esophagus rather than passing into the stomach, causing progressive difficulty swallowing. It results from the loss of inhibitory neurons in the esophageal myenteric plexus (Auerbach's plexus). While there is no cure, achalasia is very effectively managed by endoscopic procedures (pneumatic dilation or POEM) or laparoscopic Heller myotomy.
Symptoms
Progressive difficulty swallowing (dysphagia) for both solids AND liquids — a key distinguishing feature
Regurgitation of undigested food, especially at night or when lying down
Chest pain or pressure, often mistaken for cardiac pain or heartburn
Nocturnal coughing, choking, or aspiration pneumonia due to overflow
Gradual unintentional weight loss
Common Causes
Loss of inhibitory neurons (nitric oxide-producing) in the myenteric plexus of the esophageal wall — exact trigger unknown
Possible autoimmune mechanism triggered by a viral infection (HSV-1, measles suspected)
Chagas disease (Trypanosoma cruzi infection) — the main cause in Latin America; rare in Saudi Arabia
Pseudoachalasia: malignancy at the gastro-esophageal junction mimicking achalasia — always excluded at diagnosis
Self-Care Tips
Eat small, slow meals and chew food thoroughly to reduce the volume of each swallow
Remain upright for at least 2–3 hours after meals; never lie down immediately after eating
Sleep with the head of the bed elevated 15–20 cm (6–8 inches) to prevent overnight regurgitation
Drink plenty of water during meals to help wash food through
Attend all follow-up appointments even after treatment — achalasia requires lifelong monitoring for recurrence and rare cancer risk
Discuss treatment options with your specialist: pneumatic dilation, POEM (Per-Oral Endoscopic Myotomy), or Heller myotomy all have high success rates
When to See a Doctor
Progressive difficulty swallowing both solids and liquids, with or without regurgitation, is an alarm symptom requiring urgent endoscopy and esophageal manometry. Do not attribute these symptoms to stress or simple heartburn. Early diagnosis and treatment prevent esophageal dilation and reduce the small long-term risk of esophageal cancer.
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