Achalasia is the most important, well-recognised and treatable oesophageal motility disorder.

In achalasia, there is failure of the normal coordinated contraction of oesophageal muscles (peristalsis). Further, the "sphincter" muscle at the lower oesophagus cannot relax, therefore food and fluid are not let through to the stomach.

Symptoms include difficulty swallowing, food and fluid being held up in the chest, regurgitation, chest pain and weight loss.

How is achalasia diagnosed?

Both endoscopy and barium swallow can show characteristic findings in severe or longstanding disease. However, in many cases they can be completely normal.

Oesophageal high-resolution manometry is the definitive test to confirm or exclude achalasia, and is necessary prior to performing therapy.

What are the treatment options?

  • Botox injection: Relaxes the sphincter muscle to help let food through. Botox is usually initially effective but wears out in 3-6 months, so should rarely be used nowadays.

  • Pneumatic (balloon) dilatation: Via endoscopy, a balloon is placed within the sphincter muscle and inflated for 30-60 seconds. Recent studies confirm it has comparable long-term efficacy rates to surgery.

  • Heller myotomy (surgery): Nowadays performed via a keyhole approach, during the operation the surgeon makes an incision in the sphincter muscle to help open it up. Typically an anti-reflux procedure is performed at the same time. 

  • POEM:The newest treatment modality for achalasia, POEM offers an endoscopic approach to myotomy (cutting of the sphincter muscle). It appears to be comparably effective to surgery albeit with a higher rate of subsequent reflux.

One size does not fit all

Treatment for achalasia is tailored to each patient. A gastroenterologist with expertise in achalasia and high-resolution manometry is best placed to make the diagnosis and discuss which treatment option is best for you.

Dr Santosh Sanagapalli

Trusted Gastroenterologist based at St Vincent's Hospital campus, Darlinghurst.

Expert care in all aspects of gastrointestinal health with subspecialty expertise in disorders of the oesophagus.

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