Difficulty Swallowing? It Could Be Achalasia

Key Takeaways

1. Swallowing problems can signal an underlying condition: Difficulty swallowing (dysphagia) isn’t just discomfort but can point to issues with nerves, muscles, or structural problems in the throat or esophagus, and may even increase the risk of complications like pneumonia.
2. There are different types of dysphagia with different causes: Swallowing issues can occur in the mouth/throat (oropharyngeal) or the esophagus. Causes range from neurological conditions to blockages, acid reflux, or rare disorders like achalasia.
3. Achalasia develops gradually and requires testing to diagnose: Achalasia is a rare condition where the esophagus struggles to move food into the stomach. Symptoms often start subtly and worsen over time, making specialized tests essential for diagnosis.
4. Effective treatments are available and timing matters: Treatment focuses on helping food pass into the stomach, with options ranging from minimally invasive procedures to surgery. Early treatment can prevent more serious complications and improve quality of life.

Most people swallow hundreds of times per day, often without giving it a second thought. Each swallow relies on careful coordination between nerves and muscles. Together, they move saliva, foods and liquids from your mouth into your esophagus and down to your stomach.

When that process doesn’t work as it should, swallowing can become difficult, uncomfortable or even painful.

“Problems that affect swallowing can make it more difficult to eat and fuel your body,” says Brett Cohen, MD, a chief of Adult General Surgery at Memorial Healthcare System. “They can also increase the risk of food or liquid entering your lungs, which can lead to pneumonia.”

Dr. Cohen explains why swallowing difficulties happen, when they might be a sign of achalasia, and how this rare condition is treated.

What Causes Difficulty Swallowing?

Difficulty swallowing, also called dysphagia, is a symptom of many conditions. Doctors generally group swallowing problems into two main types depending on where the trouble occurs:

Oropharyngeal Dysphagia

Oropharyngeal dysphagia affects your ability to move food from your mouth into your throat during the first phase of swallowing. Conditions such as Parkinson’s disease, stroke and head and neck cancers can affect the nerves and muscles involved in this process.

Common symptoms include gagging or coughing when trying to swallow and the aspiration of food or liquids into your lungs.

Esophageal Dysphagia

Esophageal dysphagia occurs when food or liquid has trouble moving through your esophagus. It can be caused by physical blockages or problems with the muscles that squeeze food downward.

Tumors and scar tissue can narrow the esophagus, making it harder for food to pass. Gastroesophageal reflux disease (GERD) is a common cause of scarring and narrowing.

“Achalasia is a form of esophageal dysphagia that weakens muscle contractions, so food can’t pass as easily,” says Dr. Cohen. “The muscle at the bottom of the esophagus, the lower esophageal sphincter, may not relax properly. As a result, food and liquids can’t enter the stomach.”

Symptoms of esophageal dysphagia may include:

• A feeling that food is stuck in your throat or chest
• Regurgitation of undigested food back into your mouth
• Chest pain after eating
• Unintentional weight loss over time

How to Tell if Difficulty Swallowing Is Due to Achalasia

“Achalasia symptoms usually develop slowly,” says Dr. Cohen. “You may not notice these subtle changes at first. As the condition progresses, symptoms become more obvious.”

To identify the cause of dysphagia, most people are referred to a gastroenterologist. Symptoms alone aren’t enough to make a diagnosis, so testing is usually needed. Common diagnostic tests
include:

• Esophageal manometry: Measures muscle contractions in your esophagus
• Esophagram (barium swallow): An X-ray taken after swallowing a contrast liquid to show how food moves through your esophagus
• Upper endoscopy: Uses a thin, flexible camera to examine the inside of your esophagus

Achalasia Treatments

Achalasia treatment focuses on relaxing or opening the lower esophageal sphincter so that food and liquids can pass.

“Several endoscopic and surgical treatment options are available,” says Dr. Cohen. “Each treatment has its own benefits and risks.”

The table below compares three endoscopic treatments and a minimally invasive surgical option called Heller myotomy. Endoscopic procedures are performed from inside your esophagus using a flexible scope with specialized tools. Heller myotomy is a laparoscopic procedure, where instruments are inserted through small incisions in the abdomen, and is considered the gold standard treatment for achalasia.

Achalasia Treatment Comparison

It’s important to consider all your options before choosing a treatment path.

“Multiple rounds of botulinum toxin injections or balloon dilation can cause scarring. These scars may make Heller myotomy more complex later,” says Dr. Cohen.

Timing also matters. If left untreated, achalasia can cause the esophagus to stretch and deform.

Treatment may require esophageal replacement, which is a very complex procedure.

Finding Effective Relief From Achalasia

If achalasia is affecting your quality of life, expert care can make a lasting difference. With the right treatment, many people can eat more comfortably and regain a better quality of life.

General surgeons at Memorial Healthcare System provide skilled surgical care for achalasia. We offer in-depth consultations to help you determine if Heller myotomy is right for you, along with support before, during and after surgery.

Learn more about achalasia surgery at Memorial Healthcare System.