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Achalasia occurs when your esophagus cannot contract properly, and the muscle at the end – the lower esophageal sphincter – doesn’t open and close as it should. As a result, food can’t move easily from your throat to your stomach, and you experience difficulty swallowing.

Duke gastroenterologists who specialize in esophageal disease use a series of tests to diagnose achalasia and distinguish it from other esophageal problems. They are experts in confirming which type of achalasia you are experiencing and offering effective treatment so you can find relief.

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Achalasia Causes and Symptoms

How the Esophagus Works
The esophagus is a long, thin, hollow tube that contracts to push food and liquids down from the throat to the stomach. (This contraction is called peristalsis.) At the end of the esophagus, where it meets the stomach, a ring of muscle called the lower esophageal sphincter opens and closes to allow food and liquid to pass and to minimize reflux from the stomach into the esophagus. Achalasia is a “motility disorder” because the nerves and muscles in the GI tract, which control the esophagus and lower esophageal sphincter, are not working together correctly.

Causes of Achalasia
in most cases, achalasia has no known cause and isn’t associated with a condition that puts people at increased risk. It appears to occur equally in young and old people, men and women, and people of all races.

Symptoms of Achalasia
Symptoms of achalasia may include trouble swallowing that gets more difficult over time, the feeling of food stuck in the throat, and aspiration (accidentally inhaling food into your airway which causes you to choke and cough). Other symptoms can include chest pain/heartburn, regurgitation, and weight loss.

Achalasia Symptoms Can Be Confused with Other Conditions
Because achalasia symptoms can overlap with other esophageal problems, it’s important that a gastroenterologist who specializes in esophageal diseases evaluate your condition. Doctors who are less familiar with achalasia may misdiagnose it as acid reflux, and that can delay effective treatment. It’s important that achalasia is caught and treated early to prevent the esophagus from becoming very dilated and damaged.

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Duke Health offers locations throughout the Triangle. Find one near you.

Diagnosing Achalasia

If you experience symptoms of achalasia, you will meet with a gastroenterologist and other specialists, including a thoracic surgeon. They will conduct a thorough evaluation and request a series of tests to diagnose your condition.

Barium Swallow

A barium liquid is swallowed and travels the length of your esophagus. X-ray images show how food and liquid travel through your esophagus.

Upper Endoscopy (EGD)

Your doctor inserts a flexible tube into your mouth to view the inside of your esophagus, stomach, and small intestine.

Esophageal Manometry

A thin, flexible tube is inserted into your nose and placed in your esophagus. It evaluates motility by monitoring strength and patterns of muscle function within the esophagus.


During endoscopy, your gastroenterologist uses a device to measure pressures inside your esophagus and assess the ability of your esophagus to contract and relax.

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Achalasia Treatments

A gastroenterologist and thoracic surgeon will base your treatment plan on your age, other conditions you may be experiencing, the severity of your symptoms, and the type of achalasia you have. You may require more than one of the treatments listed below. Nearly all people who are treated for achalasia experience relief.

Pneumatic Dilation

During an endoscopy, a balloon is passed into the esophagus. The balloon is then inflated to loosen the lower esophageal sphincter.  This is performed as an outpatient procedure.

Heller Myotomy

During this minimally invasive procedure, your surgeon passes surgical instruments through keyhole incisions in your abdomen to reach the esophagus. Small cuts are made in the esophageal muscle to relieve pressure. In most cases, your surgeon may also wrap part of the stomach around the lower esophagus to decrease subsequent reflux. This is called a fundoplication. Robotic technologies improve visualization and allow your surgeon to better control movements when cutting the small muscle fibers of the lower esophageal sphincter.

POEM (Per-oral Endoscopic Myotomy)

During this minimally invasive procedure, an endoscope is passed through the mouth and into the esophagus. This allows doctors to see and cut the lower esophageal muscle responsible for achalasia. There are no surgical incisions. Currently, a limited number of medical centers offer this procedure.

Botox Injection

If you aren’t a candidate for pneumatic dilation or myotomy, your doctor may inject Botox into the lower esophageal sphincter through an endoscope. This temporarily relaxes the muscle. It may also be performed if a diagnosis of achalasia cannot be confirmed.

Why Choose Duke

Extensive Experience in Esophageal Disorders
Doctors from around the region refer their patients to us because of our extensive experience diagnosing and treating achalasia. Our gastroenterologists completed specialized training and are highly skilled in the diagnosis of esophageal motility disorders. Our board-certified surgeons have additional fellowship training in thoracic surgery and extensive experience in esophageal procedures.

A Dedicated Esophageal Center
Seeking care at a dedicated esophageal center means you will benefit from a team of providers who specialize in esophageal diseases and motility disorders like achalasia. For your convenience, you'll meet with a gastroenterologist and a surgeon during the same appointment. This helps ensure you receive the best testing and treatment for your type of achalasia.

We Manage Your Care for the Long Term
We continue to see you immediately after your initial treatment, then annually, to ensure you are doing well and to spot complications that can arise. We want to identify concerns early so we can treat you immediately and effectively.

Best Hospital for Gastroenterology and GI Surgery in NC

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. They are why our gastroenterology and GI surgery program is nationally ranked, and the highest-ranked program in North Carolina, according to U.S. News & World Report for 2023–2024.

This page was medically reviewed on 12/14/2022