Achalasia

  • Medical Author:
    Jay W. Marks, MD

    Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.

  • Medical Editor: Bhupinder Anand, MD
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What are the symptoms of achalasia?

The symptoms of achalasia include:

  • Difficulty swallowing food
  • Difficulty swallowing both solid and liquid food
  • Regurgitation of food that is retained in the esophagus. If this happens at night, food may be aspirated into the lungs, a serious medical problem
  • Chest discomfort from esophageal dilation and/or retained food
  • Sharp chest pain usually of unclear cause
  • Heartburn; however, the heartburn is not characteristic of heartburn and is not helped by treatment for heartburn
  • Loss of weight due to reduced intake of food

What causes achalasia?

The cause of achalasia is unknown. Theories on causation invoke infection, heredity or an abnormality of the immune system that causes the body itself to damage the esophagus (autoimmune disease).

The esophagus contains both muscles and nerves. The nerves coordinate the relaxation and opening of the sphincters as well as the peristaltic waves in the body of the esophagus. Achalasia has effects on both the muscles and nerves of the esophagus; however, the effects on the nerves are believed to be the most important. Early in achalasia, inflammation can be seen (when examined under the microscope) in the muscle of the lower esophagus, especially around the nerves. As the disease progresses, the nerves begin to degenerate and ultimately disappear, particularly the nerves that cause the lower esophageal sphincter to relax. Still later in the progression of the disease, muscle cells begin to degenerate, possibly because of the damage to the nerves. The result of these changes is a lower sphincter that cannot relax and muscle in the lower esophageal body that cannot support peristaltic waves. With time, the body of the esophagus stretches and becomes enlarged (dilated).

Medically Reviewed by a Doctor on 7/24/2015

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