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Detailed chapter

Gastroesophageal Reflux (GERD) — Achalasia

Esophageal motility disorder and dysphagia

Achalasia is failure of the lower esophageal sphincter to relax with impaired esophageal peristalsis. Dysphagia, food stasis, and regurgitation mimic other diseases but heartburn is not typical. Diagnosis requires manometry; treatment includes pneumatic dilation, POEM, or Heller myotomy.

Achalasia · educational illustration

Outcomes of any surgical or interventional procedure may vary from person to person. Please seek a detailed consultation with your physician before any procedure.

© Cengiz Dibekoğlu — illustrative; not for unauthorized use

Figure summary

This educational figure shows: Achalasia.

Key points

  • Symptoms

    In achalasia, dysphagia to both solids and liquids is typical; regurgitation, food stasis, chest discomfort, and weight loss may accompany it.

  • Diagnosis

    Key note inside

    Endoscopy excludes alternate causes; barium swallow may show bird-beak narrowing. Unexplained dysphagia should not be labeled reflux alone — mechanical obstruction and motility disorders must be excluded. High-resolution manometry is the key test to confirm achalasia.

  • Treatment

    Pneumatic dilation, POEM, or Heller myotomy are selected by anatomy, experience, and patient factors. Partial fundoplication after Heller may reduce reflux risk.

  • Follow-up

    Key note inside

    Follow-up is individualized to symptoms and treatment response; routine endoscopic surveillance for cancer screening alone is not standard. Long-standing food stasis carries megaesophagus risk.

Frequently asked questions

  • Is achalasia the same as reflux?

    No. PPIs do not treat achalasia; manometry distinguishes the two.

Evidence

Scientific sources

Show sources · 2

ACG / ASGE upper-GI motility guidance for achalasia diagnosis (manometry) and treatment. It must not be confused with GERD.

  1. 1. ACG clinical guidelines — GI disease and colorectal cancer screeningAmerican College of Gastroenterology (ACG) · Living guidelinesOpen source →
  2. 2. ASGE guideline library — endoscopy, polypectomy, and achalasiaAmerican Society for Gastrointestinal Endoscopy (ASGE) · Guideline libraryOpen source →

Last reviewed: 21 August 2026. Links go to publisher pages.

This page is for education. It is not medical advice and does not replace a visit with your physician.

Medical editor: Assoc. Prof. Cengiz Dibekoğlu, MD · Last medically reviewed: August 2026 · English patient-education chapter.