Achalasia: Causes, Symptoms, and Treatment
Medically reviewed by Achuta Uppu, MD, Internal Medicine. Last reviewed: October 23, 2026.
What kind of doctor treats Achalasia?
Achalasia is treated by a gastroenterologist (a doctor who treats the digestive system). Some people may need a surgeon (a doctor who does operations) to cut the muscle that does not relax. A direct primary care or concierge doctor can be a first stop for an evaluation and can refer you to a specialist when needed.
What is achalasia?
Achalasia is a rare disorder of the esophagus, the tube that carries food from your throat to your stomach. It makes it hard for the esophagus to push food down. A ring of muscle sits where the esophagus meets the stomach. It is called the lower esophageal sphincter (LES). Normally, this muscle relaxes when you swallow. In achalasia, it does not relax as it should. The squeezing motion that moves food down (peristalsis) is also weak or missing.
This problem comes from damage to the nerves of the esophagus.
Symptoms
Symptoms usually start slowly. Trouble swallowing (dysphagia) is the main early sign. Other symptoms include:
- Backflow (regurgitation) of food.
- Chest pain. It may get worse after eating, or you may feel it in your back, neck, or arms.
- A cough at night.
- Trouble swallowing both liquids and solids.
- Heartburn.
- Weight loss without trying.
Food and saliva can stay in the esophagus and come back up. They can also be breathed into the lungs. Some people have dry eyes or a dry mouth.
Causes and who gets it
The exact cause of achalasia is not known. It happens when the nerves in the esophagus are damaged. Some researchers think a group of nerves in the chest breaks down. A rare form may be passed down in families.
Achalasia is rare. It can happen at any age, but it is most common in people ages 25 to 60. A parasite infection called Chagas disease can cause similar symptoms. It is more common in Mexico and Central and South America. Cancer of the esophagus or upper stomach can also cause similar symptoms.
How doctors diagnose it
Esophageal manometry confirms the diagnosis. It is a test that measures how well the esophagus works. Other tests are often done too. An upper endoscopy uses a flexible tube with a camera to look at the lining of the esophagus and stomach. An upper GI x-ray uses barium, a chalky drink. It can show a stretched esophagus that holds food and liquid.
Treatment
Treatment aims to lower the pressure at the sphincter muscle. This lets food and liquids pass into the stomach. Treatment options may include:
- Botox (botulinum toxin) injection. It may help relax the sphincter, but the benefit wears off within a few weeks or months.
- Medicines such as long-acting nitrates or calcium channel blockers. They can relax the sphincter, but there is rarely a long-term solution with medicines.
- Pneumatic balloon dilation. A balloon stretches the sphincter during endoscopy. About 70 percent of cases may be treated effectively this way. Many people may need repeated dilations.
- Surgery (a myotomy) cuts the muscle fibers of the sphincter. A surgeon can do it with a laparoscope (a thin camera tube) or through endoscopy as POEM (per oral endoscopic myotomy). Surgery may be effective in about 85 to 90 percent of cases.
Outcomes of surgery and non-surgical treatments are similar. More than one treatment is sometimes necessary. Your health care provider can help you decide which treatment is best for you.
When to see a doctor
Call your provider if you have trouble swallowing or painful swallowing. Also call if your symptoms continue even with treatment for achalasia. Call 911 or go to the emergency room if you have trouble breathing, chest pain or discomfort that lasts two minutes or more, or you vomit blood. Get medical help right away if you breathe food or liquid into your lungs. This is called aspiration (breathing contents into the lungs). It can cause pneumonia (a lung infection).
How a direct primary care or concierge doctor fits in
A direct primary care doctor charges a flat monthly fee instead of billing insurance, while a concierge doctor usually charges more and often works alongside insurance. This kind of doctor can watch for weight loss and trouble swallowing over time. They can also refer you to a specialist when needed.
Common questions
Can achalasia be prevented?
Often not. Many of the causes of achalasia cannot be prevented. Treatment may help prevent complications.
What problems can achalasia cause?
Food and saliva breathed into the lungs may cause pneumonia and other lung infections. Weight loss can happen in people who are not treated, because swallowing is hard. The risk of esophageal cancer is higher than in other people.
Do I need surgery for achalasia?
Not always. Medicines may provide some relief, and balloon dilation may treat about 70 percent of cases effectively. Surgery may be effective in about 85 to 90 percent of cases. Your health care provider can help you decide which treatment is best for you.
Sources
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
