Print DiagnosisAchalasia can be overlooked or misdiagnosed because it has symptoms similar to other digestive disorders. To test for achalasia, your doctor is likely to recommend: Esophageal manometry. This test measures the rhythmic muscle contractions in your esophagus when you swallow, the coordination and force exerted by the esophagus muscles, and how well your lower esophageal sphincter relaxes or opens during a swallow. This test is the most helpful when determining which type of motility problem you might have. X-rays of your upper digestive system (esophagram). X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows your doctor to see a silhouette of your esophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help to show a blockage of the esophagus. Upper endoscopy. Your doctor inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Endoscopy can be used to define a partial blockage of the esophagus if your symptoms or results of a barium study indicate that possibility. Endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications of reflux such as Barrett's esophagus. Read more about esophageal manometry and upper endoscopy. Care at Mayo Clinic Our caring team of Mayo Clinic experts can help you with your achalasia-related health concerns Start Here TreatmentAchalasia treatment focuses on relaxing or stretching open the lower esophageal sphincter so that food and liquid can move more easily through your digestive tract. Specific treatment depends on your age, health condition and the severity of the achalasia. Nonsurgical treatmentNonsurgical options include: Pneumatic dilation. A balloon is inserted by endoscopy into the center of 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. Nearly one-third of people treated with balloon dilation need repeat treatment within five years. This procedure requires sedation. Botox (botulinum toxin type A). This muscle relaxant can be injected directly into the esophageal sphincter with an endoscopic needle. The injections may need to be repeated, and repeat injections may make it more difficult to perform surgery later if needed. Botox is generally recommended only for people who aren't good candidates for pneumatic dilation or surgery due to age or overall health. Botox injections typically do not last more than six months. A strong improvement from injection of Botox may help confirm a diagnosis of achalasia. Medication. Your doctor might suggest muscle relaxants such as nitroglycerin (Nitrostat) or nifedipine (Procardia) before eating. These medications have limited treatment effect and severe side effects. Medications are generally considered only if you're not a candidate for pneumatic dilation or surgery, and Botox hasn't helped. This type of therapy is rarely indicated. SurgerySurgical options for treating achalasia include: Heller myotomy. The surgeon cuts the muscle at the lower end of the esophageal sphincter to allow food to pass more easily into the stomach. The procedure can be done noninvasively (laparoscopic Heller myotomy). Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD). To avoid future problems with GERD, a procedure known as fundoplication might be performed at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of your stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back (GERD) into the esophagus. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure. Peroral endoscopic myotomy (POEM). In the POEM procedure, the surgeon uses an endoscope inserted through your mouth and down your throat to create an incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter. POEM may also be combined with or followed by later fundoplication to help prevent GERD. Some patients who have a POEM and develop GERD after the procedure are treated with daily oral medication. Request an appointment There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form. Get the latest health information from Mayo Clinic delivered to your inbox. 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Thank you for subscribing Your in-depth digestive health guide will be in your inbox shortly. You will also receive emails from Mayo Clinic on the latest health news, research, and care. If you don’t receive our email within 5 minutes, check your SPAM folder, then contact us at newsletters@mayoclinic.com. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry Clinical trials Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition. By Mayo Clinic Staff Achalasia care at Mayo Clinic Request an appointment Symptoms & causesDoctors & departments May 11, 2023 Print Share on: FacebookTwitter Show references Zaninotto G, et al. The 2018 ISDE achalasia guidelines. Diseases of the Esophagus. 2018; doi:10.1093/dote/doy071. Achalasia. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/achalasia/. Accessed April 6, 2020. Achalasia. Canadian Society of Intestinal Research. https://badgut.org/information-centre/a-z-digestive-topics/achalasia/. Accessed April 6, 2020. Swanstrom LL. Achalasia: Treatment, current status and future advances. Korean Journal of Internal Medicine. 2019; doi:10.3904/kjim.2018.439. Jung HK, et al. 2019 Seoul consensus on esophageal achalasia guidelines. Neurogastroenterology and Motility. 2020; doi:10.5056/jnm20014. Achalasia. Merck Manual Professional Version. https://www.merckmanuals.com/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/achalasia. Accessed April 6, 2020. Ahmed Y, et al. Peroral endoscopic myotomy (POEM) for achalasia. Journal of Thoracic Disease. 2019; doi:10.21037/jtd.2019.07.84. Brown AY. Allscripts EPSi. Mayo Clinic. March 12, 2020. Blackmon SH (expert opinion). Mayo Clinic. 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There is a problem with information submitted for this request. Review/update the information highlighted below and resubmit the form. Get the latest health information from Mayo Clinic delivered to your inbox. Subscribe for free and receive your in-depth guide to digestive health, plus the latest on health innovations and news. You can unsubscribe at any time. Click here for an email preview. Email address ErrorEmail field is required ErrorInclude a valid email address Subscribe Learn more about Mayo Clinic’s use of data. To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail. Thank you for subscribing Your in-depth digestive health guide will be in your inbox shortly. You will also receive emails from Mayo Clinic on the latest health news, research, and care. If you don’t receive our email within 5 minutes, check your SPAM folder, then contact us at newsletters@mayoclinic.com. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry