Achalasia is a rare disorder that makes it difficult for food and liquid to pass into your stomach. Achalasia occurs when the food tube (esophagus) loses the ability to squeeze food down, and the muscular valve between the esophagus and stomach doesn't fully relax.

The reason for these problems is damage to the nerves in the esophagus, which may be caused by an abnormal immune system response. There's no cure, but achalasia symptoms can usually be managed with minimally invasive therapy or surgery.

  • Expertise. Each year, Mayo Clinic doctors diagnose and treat more than 400 people with achalasia. Specialists at Mayo Clinic are skilled in distinguishing achalasia from other digestive tract disorders, and use state-of-the-art imaging to pinpoint the cause of your problem.
  • Minimally invasive approach. If you need surgery for achalasia, surgeons at Mayo Clinic often use a device called a laparoscope that allows them to perform surgery with only minor incisions. Laparoscopic procedures usually involve less pain and have a faster recovery period than traditional surgery.
  • Surgery with no outer incision. Peroral endoscopic myotomy (POEM) is available for treating achalasia at Mayo Clinic. In this technique, doctors use instruments attached to a lighted, video-equipped tube (endoscope) passed through the mouth and esophagus to make an internal incision in the muscular valve at the lower end of the esophagus. The POEM procedure doesn't require an incision through the abdomen.
  • New ideas. Researchers at Mayo Clinic are researching new treatments for achalasia. You have access to the expertise of Mayo Clinic clinician-researchers.

Mayo Clinic in Rochester, Minn., ranks #1 for digestive disorders in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Scottsdale, Ariz., is ranked among the Best Hospitals and Mayo Clinic in Jacksonville, Fla., is ranked high performing for digestive disorders by U.S. News & World Report.

At Mayo Clinic, we assemble a team of specialists who take the time to listen and thoroughly understand your health issues and concerns. We tailor the care you receive to your personal health care needs. You can trust our specialists to collaborate and offer you the best possible outcomes, safety and service.

Mayo Clinic is a not-for-profit medical institution that reinvests all earnings into improving medical practice, research and education. We're constantly involved in innovation and medical research, finding solutions to improve your care and quality of life. Your doctor or someone on your medical team is likely involved in research related to your condition.

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Achalasia can be difficult to diagnose because it has symptoms similar to other digestive disorders. Radiologists and esophageal disease specialists at Mayo Clinic have experience recognizing achalasia.

Tests useful in diagnosing achalasia include:

  • High-resolution esophageal manometry. Using a catheter inserted down your esophagus, muscle contractions in your esophagus are measured when you swallow water. High-resolution manometry — which is available at Mayo Clinic — can assess the severity of your achalasia and guide treatment decisions.
  • Esophagram (barium swallow). An X-ray visualizes movement of liquids through your esophagus when you swallow.
  • Endoscopy. A flexible, narrow tube (endoscope) with a camera is used to view the inside of the esophagus and stomach.

Read more about esophageal manometry and endoscopy.

Achalasia treatment focuses on relaxing or forcing open the valve between the esophagus and stomach (lower esophageal sphincter) so that food and liquid can move more easily through your digestive tract.

Specific treatment depends on your age and the severity of the condition. The options include:

  • Balloon dilation. A balloon is inserted into the esophageal sphincter and inflated to enlarge the opening. This outpatient procedure may need to be repeated if the esophageal sphincter doesn't stay open. Between one-third and one-half of the people treated need a repeat balloon dilation within 10 years.
  • Surgery. Mayo Clinic surgeons use a minimally invasive procedure (laparoscopic Heller myotomy) to cut the muscle at the lower end of the esophageal sphincter. People who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD).

    To prevent reflux problems, surgeons at Mayo Clinic sometimes do a second procedure (fundoplication) during the surgery when the esophageal sphincter muscle is cut. Surgery may be the preferred option for younger people, because balloon dilation tends to be less effective in this group. Surgery can be used to treat all age groups.

    A newer procedure, called peroral endoscopic myotomy (POEM), doesn't require incisions on the outside of your body or digestive tract. Instead, doctors use an endoscope inserted through your mouth and down your throat and create an incision in the inside lining of your esophagus. Then, as in the Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.

    Gastroesophageal reflux is a common side effect of this procedure. Because this technique was recently developed, more studies need to be done, particularly on the long-term outcomes of this type of surgery.

  • Botox (botulinum toxin). This muscle relaxant can be injected directly into the esophageal sphincter with an endoscope. Studies indicate that the injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Specialists at Mayo Clinic usually use Botox only for older adults and those who aren't good candidates for surgery.

Mayo Clinic works with hundreds of insurance companies and is an in-network provider for millions of people. In most cases, Mayo Clinic doesn't require a physician referral. Some insurers require referrals or may have additional requirements for certain medical care. All appointments are prioritized on the basis of medical need.

Specialists in gastroenterology usually manage care for adults who have achalasia.

For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology usually manage care for adults who have achalasia.

For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.

Specialists in gastroenterology usually manage care for adults and children who have achalasia. An esophageal group within gastroenterology specializes in studying and treating complex disorders of the esophagus, including achalasia.

For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.

See information on patient services at the three Mayo Clinic locations, including transportation options and lodging.

Mayo Clinic researchers are working on ways to better diagnose and treat achalasia, including studying the long-term effectiveness of achalasia therapies.

See a list of publications by Mayo Clinic doctors on achalasia on PubMed, a service of the National Library of Medicine.

Mar. 31, 2015