Achalasia: Symptoms, Causes, and Getting Help in the UK

Achalasia is a rare but impactful digestive condition that affects the oesophagus (the muscular tube connecting the throat to the stomach). In a healthy digestive system, the muscles of the oesophagus contract in a wave-like motion (peristalsis) to push food downward. Additionally, a muscular ring at the bottom, known as the lower oesophageal sphincter (LOS), relaxes to let food enter the stomach.

In patients with achalasia, two things go wrong: the nerves in the oesophagus become damaged, stopping the muscular contractions, and the LOS fails to open properly. This results in food and liquid getting stuck in the chest, leading to a range of uncomfortable and sometimes painful symptoms. According to NHS data, achalasia can affect people of any age, though it is most commonly diagnosed in adults between 30 and 60 years old.

Symptoms of achalasia usually develop gradually, often over several months or years. Many British patients initially mistake the symptoms for common acid reflux or GORD (gastro-oesophageal reflux disease). However, the distinguishing feature is often the difficulty in swallowing both solids and liquids.

Primary Symptoms:

• Dysphagia: Feeling like food is stuck in your throat or chest after eating.
• Regurgitation: Bringing up undigested food, particularly when lying down at night.
• Chest Pain: A sharp or dull pain in the chest that can be mistaken for a heart attack.
• Heartburn: Although not caused by acid, the fermentation of food in the oesophagus can feel like burning.
• Weight Loss: Significant unintentional weight loss due to the inability to eat normally.
• Persistent Cough: Often occurring at night as food or liquid enters the airways (aspiration).

The exact cause of achalasia is not fully understood, but it is widely believed to be an autoimmune response. This involves the body's immune system attacking the nerve cells (ganglion cells) in the walls of the oesophagus. In rare cases, it can be linked to viral infections.

If you suspect you have achalasia, your GP will likely follow NICE (National Institute for Health and Care Excellence) guidelines for investigation. Diagnosis usually involves a series of hospital-based tests:

• Manometry: A small tube is inserted into the nose to measure the pressure and muscle contractions in the oesophagus. This is the 'gold standard' for diagnosing achalasia.
• Barium Swallow: You drink a chalky liquid that shows up on X-rays, allowing doctors to see the 'bird’s beak' appearance of the lower oesophagus.
• Endoscopy: A camera is used to look inside the throat to rule out other conditions such as oesophageal cancer.

While there is currently no way to restore the nerve function in the oesophagus, treatments focus on relaxing or forcing open the lower oesophageal sphincter to allow food to pass into the stomach.

Common UK Treatments:

• Pneumatic Dilation: A balloon is passed into the sphincter and inflated to stretch the muscle fibres. This may need to be repeated.
• Heller Myotomy: A surgical procedure where the muscle fibres of the sphincter are cut. This is often performed laparoscopically (keyhole surgery) and is highly effective.
• POEM (Peroral Endoscopic Myotomy): A newer, less invasive technique where the surgeon reaches the sphincter through the mouth using an endoscope.
• Botox Injections: For patients who cannot undergo surgery, Botox can be injected into the sphincter to relax it, though the effects usually wear off after several months.

If you are experiencing persistent difficulty swallowing, it is essential to seek medical advice promptly. You can speak to a GP online in the UK for an initial assessment. An online doctor can take a detailed clinical history, discuss the nature of your symptoms, and determine if your concerns are likely related to achalasia or another condition like GORD.

Because achalasia is rare, a consultation can be vital in excluding more common issues and ensuring you are directed toward the correct specialist (a gastroenterologist). If necessary, an online doctor can provide a private referral or documentation to support your NHS pathway, helping you take the first step toward a definitive diagnosis and treatment plan.

Managing achalasia involves making lifestyle adjustments to make swallowing easier and reduce the risk of complications like aspiration pneumonia. NHS guidance suggests several helpful strategies:

• Eat slowly: Take small bites and chew your food thoroughly until it is a liquid consistency.
• Drink plenty of water: Sipping water during meals can help gravity move food through the sphincter.
• Eat upright: Ensure you are sitting straight while eating and remain upright for at least two hours after meals.
• Sleep elevated: Use extra pillows or a wedge to keep your head raised at night to prevent regurgitation.
• Avoid triggers: Some find that very cold foods or fizzy drinks can make the spasms in the oesophagus worse.