Health condition
Achalasia deep dive
Achalasia is a rare swallowing disorder in which the lower oesophageal valve fails to relax and the gullet loses its coordinated pumping; high-resolution manometry classifies the subtype and three definitive treatments offer durable relief.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key points
What matters most, at a glance.
The essentials in plain English - symptoms, when to seek help, who to see and what treatment looks like.
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Difficulty swallowing both solids and liquids, regurgitation of undigested food and slow weight loss are the classic features
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Symptoms are frequently mislabelled as reflux for years - unresponsive "reflux" with regurgitation deserves motility testing
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High-resolution manometry is the definitive test and classifies achalasia into types I-III, which guides treatment choice
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Pneumatic dilatation, laparoscopic Heller myotomy and POEM all achieve durable relief in experienced hands
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Lifelong follow-up matters: treated achalasia carries a small long-term risk of oesophageal complications
Understanding it
About Achalasia deep dive, and what to do next.
In achalasia the nerve cells controlling the lower oesophageal sphincter degenerate, so the valve stays closed and the oesophagus above gradually dilates. Endoscopy and a timed barium swallow raise suspicion, but manometry makes the diagnosis; type III (spastic) achalasia in particular responds best to treatments that address the longer spastic segment, such as POEM.
Treatment aims to open the valve permanently rather than manage symptoms: balloon dilatation, surgical myotomy with an anti-reflux wrap, or peroral endoscopic myotomy. Choice depends on subtype, age, fitness and preference, and is best made with a team that offers all three. Most people start with their GP, who can refer to a consultant gastroenterologist with expertise in oesophageal motility (neurogastroenterology). In many parts of the UK, routine NHS referrals for this kind of problem currently take 20-45+ weeks, whereas an initial private consultation is typically available within around two weeks.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any emergency symptoms described above.
Frequently asked
Common questions about Achalasia deep dive.
Quick, plain-English answers to what people ask us most.
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What is achalasia?
Achalasia is a rare disorder of the oesophagus where the muscle at the bottom (the lower oesophageal sphincter) fails to relax properly, and normal swallowing muscle contractions are lost, making it hard for food and liquid to pass into the stomach.
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What causes achalasia?
The exact cause is unknown in most cases, but it is thought to involve gradual loss of nerve cells controlling the oesophagus, possibly triggered by an autoimmune process, sometimes following a viral infection.
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What are the symptoms of achalasia?
Common symptoms include difficulty swallowing solids and liquids, regurgitation of undigested food, chest pain, heartburn-like discomfort, and unintentional weight loss as the condition progresses.
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Is achalasia serious?
Yes, if untreated it can lead to significant weight loss, malnutrition, aspiration of food into the lungs, and a modestly increased long-term risk of oesophageal cancer, so ongoing specialist monitoring is important.
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Is achalasia hereditary?
Achalasia is not typically inherited in a straightforward genetic pattern, though very rare familial clusters have been reported, and most cases appear to occur sporadically.
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Can achalasia be cured?
There is no cure that restores normal oesophageal nerve function, but treatments can very effectively relieve the blockage and symptoms, allowing most people to eat and swallow comfortably again.
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How is achalasia treated?
Treatment options include pneumatic dilation, Botox injections into the sphincter, and surgical or endoscopic procedures such as Heller myotomy or POEM, chosen based on age, fitness, and disease severity.
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How long does it take to recover from achalasia treatment?
Recovery from endoscopic procedures like Botox or dilation is usually rapid, often within days, while surgical options like Heller myotomy or POEM typically involve one to two weeks of recovery before returning to normal activities.
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Achalasia vs GORD (acid reflux) — what's the difference?
GORD involves excess acid flowing back into the oesophagus, often worsened by lying down or eating certain foods, while achalasia is a mechanical problem preventing food from passing into the stomach at all, causing regurgitation of undigested food rather than acid.
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When should I see a doctor about achalasia, and how quickly can I be seen privately?
See a doctor if you have persistent difficulty swallowing or unexplained weight loss. NHS gastroenterology referral can take 20 to 45 or more weeks, while private specialist assessment is often available within about two weeks.