What Is Achalasia? Symptoms, Diagnosis and Treatment Methods

Created: 05.05.2026  ·  Last Updated: 24.07.2026  ·  Category: Gastroenterology  ·  Prepared by the Academic Hospital Web and Medical Editorial Board.

What Is Achalasia?

The name of the disease comes from the Greek word “a-khalasis,” meaning “failure to relax.” Normally, during swallowing, the muscles in the esophagus contract in a wave-like pattern to move food downward, and the valve at the lower end, called the lower esophageal sphincter, relaxes to allow food to pass into the stomach. In achalasia, this coordinated movement is disrupted. Because the muscles at the lowest part of the esophagus cannot relax adequately, the passage of food into the stomach becomes difficult. Although rare, achalasia can lead to serious problems if left untreated.

Important Information: Gastroenterology evaluation is important if swallowing difficulty with both solids and liquids, nighttime coughing, regurgitation or unexplained weight loss is present. Achalasia may be confused with reflux, so the diagnosis should be clarified with tests.

Achalasia Causes and Risk Factors

  • It can occur at any age, but it is most commonly diagnosed between the ages of 25 and 60.
  • It occurs with equal frequency in women and men.
  • The risk may increase in people with autoimmune disease.
  • It should be noted that achalasia is not a hereditary disease. The risk may increase very slightly in people with a family history of achalasia, but no direct inheritance pattern from parent to child has been defined.
  • Some viral infections are thought to potentially trigger the disease by affecting nerve tissue.

You can contact us for evaluation of achalasia symptoms and the diagnostic process.

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What Are the Symptoms of Achalasia?

  • Dysphagia (swallowing difficulty): It is seen in more than 90% of patients. With both solid and liquid foods, there is a feeling that the bite is stuck in the chest area. It is the most important symptom seen in achalasia.
  • Regurgitation: Food or saliva that cannot pass into the stomach comes back into the mouth. It becomes especially noticeable when lying down.
  • Chest pain: Retrosternal pain, felt behind the breastbone, is seen in approximately 40-60% of patients. It may sometimes be confused with heart pain or reflux.
  • Weight loss: It occurs as a result of inadequate nutrition due to swallowing difficulty and avoiding food.
  • Nighttime cough and aspiration: Food accumulating in the esophagus may enter the lungs while lying down at night.
Attention: Coughing attacks while lying down at night may suggest achalasia. If swallowing difficulty with both solid and liquid foods lasts longer than 2 weeks, consult a gastroenterology specialist.

Types of Achalasia and Diagnostic Process

Achalasia is not a single-type disease; it has different subtypes. This distinction is made with a special measurement method called “high-resolution manometry (HRM).” In this method, the muscle movements of the esophagus are examined in detail. This system, called the Chicago Classification (v4.0), divides achalasia into three different types. HRM both establishes the diagnosis and determines the type of the disease.

Methods that can be used in the diagnosis of achalasia:

  • Barium Swallow Study (Esophagogram): The patient drinks a barium-containing liquid and X-rays are taken. In achalasia, narrowing in the lower part and widening in the upper part may be observed.
  • Upper Gastrointestinal Endoscopy (Gastroscopy): The esophagus and stomach are directly examined with an endoscope. It is performed to rule out other diseases that may cause symptoms similar to achalasia. The endoscope passes into the stomach with difficulty.
  • Timed Barium Esophagram (TBE): The passage time of the swallowed substance through the esophagus is measured. It is also used to monitor recovery after treatment.

Achalasia Treatment Methods

In achalasia, treatment selection must be individualized. The same method is not suitable for every patient. Regular follow-up is required after treatment.

  • Balloon dilation
  • Laparoscopic Heller myotomy (LHM)
  • Peroral endoscopic myotomy (POEM)
  • Botulinum toxin (Botox) injection
  • Medication therapy: It is generally not the first choice and does not provide a permanent solution. However, it may be used in patients who are not suitable for surgery or interventional treatment, or to provide temporary relief.

Get Evaluated for Achalasia Symptoms

Specialist evaluation is important for diagnosis and treatment planning in symptoms such as swallowing difficulty, regurgitation, nighttime cough or weight loss.

Frequently Asked Questions

Is achalasia a dangerous disease?
It is not directly life-threatening. However, if untreated, swallowing difficulty may increase, and weight loss and nutritional problems may develop. In the long term, esophageal dilation and rarely an increased cancer risk may occur.
Can achalasia be completely cured?
It does not completely disappear. However, symptoms can be largely controlled with treatment, and patients can continue their normal lives.
What is the difference between achalasia and reflux?
In achalasia, the valve at the lower end of the esophagus does not open adequately; therefore, swallowed food has difficulty passing into the stomach and the person experiences swallowing difficulty. In reflux, the opposite occurs; this valve remains loose and stomach acid escapes upward into the esophagus. In short, achalasia is a “failure to pass” problem, while reflux is a “backflow” problem.
Is the manometry test painful?
It is generally not painful; however, because a thin tube is passed through the nose, brief discomfort may be felt. The procedure usually takes a few minutes and can be tolerated by most patients.
Academic Hospital note: In achalasia, treatment choice should be planned individually according to the patient’s age, symptoms, manometry findings, accompanying diseases and applicable interventional methods. You can book an appointment for evaluation.

References

  1. Cleveland Clinic. Achalasia: Symptoms, Causes, Types, Treatments
  2. Mayo Clinic. Achalasia - Symptoms and causes
  3. ACG Clinical Guideline. Diagnosis and Management of Achalasia
  4. Chicago Classification v4.0. Esophageal Motility Disorders on High Resolution Manometry