Dealing with Achalasia: Esophageal spasms and discomfort

AHALAZIJA (achalasia) involves a disorder of esophageal peristalsis and the relaxation of the lower esophageal sphincter, caused by a lack of ganglia in the Auerbach plexus. Symptoms include dysphagia—difficulty swallowing both solid and liquid foods—chest pain, and regurgitation. Treatment options like nitrates and hydralazine can help manage symptoms, while a complete fix usually requires either cardiomyotomy or balloon dilation of the esophagus.

This condition affects about 1 in 1,000,000 people annually. Because many aren't familiar with it, they often misattribute it to eating disorders like bulimia or anorexia. It’s relatively straightforward to diagnose via an esophageal X-ray (once food gets stuck) or a gastroscopy. Essentially, the esophagus develops spasms that tighten rather than relax, trapping food so it can't move up or down.
You’re born with this condition, so there’s no controlling its onset. Typically, the inability to swallow dry or hard foods develops gradually; in my case, it was triggered by sunstroke.
It impacts the entire gastrointestinal tract, which can lead to secondary issues in the stomach (like gastritis or ulcers) and the intestines.
Medications used include nitrates (ISMN), taken sublingually before meals. Balloon dilation (stretching the esophagus) isn't always effective and the process can take up to two years. Cardiomyotomy is an invasive procedure that really needs to be performed by a specialist, as it carries a risk of gastroesophageal reflux—where everything meant for the stomach ends up coming back up involuntarily.
A few years ago, I was at a breaking point because doctors struggled to diagnose me given how rare the disease is. After eight months, I finally saw Dr. Opačić at Mount Sinai, and he was able to identify it. I'm so grateful to him!
Fortunately, my situation isn't too severe, and I've learned how to manage it. Some days are harder than others. I have to be very mindful of every bite, regardless of any medication. I haven't had surgery or dilation; I've simply learned how to live with it.

Ugh, I’m dealing with the exact same thing... if you stumble onto any new treatments, meds, herbal teas... honestly, anything at all... please post it here.🙂
thanks in advance.

So, here’s my situation... I’ve been dealing with esophageal stenosis as a complication from primary Crohn's disease. It’s been a real struggle for about three years now. Honestly, I couldn't even swallow—like, I would literally choke. I couldn't get down even the smallest pill, nothing at all. Since then, I've had four dilatations done... three using a balloon method and one using some kind of tubes, though I guess I don't really know what that specific procedure is called. It was all done at the Mayo Clinic, and things are much better now; I can swallow more or less normally. I mean, food still feels a bit heavy sometimes, but I can take my pills just fine. The only thing was once when an Augmentin tablet got stuck, but I think... well, Augmentin is such a massive pill, so I guess I shouldn't be too surprised about that. I stay on top of things with regular endoscopies, and that seems to do the trick.

Ever since my gallbladder surgery and that intense endoscopy, swallowing has been a total nightmare. I had an esophageal diascopy done, and it turns out there’s some serious narrowing going on... and now I've officially been diagnosed with AHALAZIJA. I was scrolling through this forum and saw a post above that hit way too close to home—the regurgitation, especially at night, the heavy coughing fits while sleeping, the trouble swallowing, and those constant stomach pains... it's basically my life right now. I'm just trying to navigate this mess. Honestly, I'd love to connect with someone who actually gets it and can swap stories about dealing with the same stuff. Is surgery really the only way out? I have to go in for an endoscopy once a year just to stay on top of things and make sure nothing catastrophic happens. My doctor's take is that we should wait until I literally can't swallow anymore before even considering surgery. The absolute worst part of this whole ordeal? I have a massive appetite and I am hungry all the time.

rapidbadger8 said:Ever since my gallbladder surgery and that intense endoscopy, swallowing has been a total nightmare. I had an esophageal diascopy done, and it turns out there’s some serious narrowing going on... and now I've officially been diagnosed with AHALAZIJA. I was scrolling through this forum and saw a post above that hit way too close to home—the regurgitation, especially at night, the heavy coughing fits while sleeping, the trouble swallowing, and those constant stomach pains... it's basically my life right now. I'm just trying to navigate this mess. Honestly, I'd love to connect with someone who actually gets it and can swap stories about dealing with the same stuff. Is surgery really the only way out? I have to go in for an endoscopy once a year just to stay on top of things and make sure nothing catastrophic happens. My doctor's take is that we should wait until I literally can't swallow anymore before even considering surgery. The absolute worst part of this whole ordeal? I have a massive appetite and I am hungry all the time.

Unfortunately, the club keeps growing. They recently slapped an achalasia diagnosis on me, even though I've been battling gastritis for years. Looking back, the achalasia stuff probably started ages ago, but the doctors just kept chalking everything up to the gastritis. About two years ago, the vomiting kicked in. Now, I'm basically eating on my feet; I've had to learn these weird breathing techniques and specific postures just to try and widen the esophagus enough to get food down without throwing it all back up. It’s a constant prayer. Some days are better than others, but there isn't a single "good" day left where I can just eat or drink like a normal person. I lost a terrifying amount of weight for a while, but I finally managed to put it back on. I've sort of made my peace with the situation for now. I'm going to keep pushing off any kind of medical procedure until things get truly dire. Then, we'll see what happens.

Good afternoon, everyone,

I was wondering if any of you have gone ahead and moved forward with surgery yet? If so, I’m really curious about which specific procedure you opted for—since there are several different methods out there, I’d love to know what you actually had done and whether you’re feeling any better now. Also, have you reached a point where you can go back to eating everything again?

Sarah Vaughn94 said:Good afternoon, everyone,

I was wondering if any of you have gone ahead and moved forward with surgery yet? If so, I’m really curious about which specific procedure you opted for—since there are several different methods out there, I’d love to know what you actually had done and whether you’re feeling any better now. Also, have you reached a point where you can go back to eating everything again?

I went in for an esophageal dilation about a year ago, and honestly, I'm thrilled with how things turned out. It’s a pretty straightforward procedure—takes maybe 30 minutes or so, done under general anesthesia, and you’re headed home the very same day. For me, my symptoms haven't come back at all; no flare-ups, nothing. I can eat and drink whatever I want without any issues. If I were you, I wouldn't hesitate to get it done. You'll feel like a whole new person afterward. Good luck!

And if I might be so bold as to ask, how old are you now? And how long have you actually been dealing with AHALAZIJA?
In other words, I am curious to know just how many years passed while you were living with AHALAZIJA before you finally decided to undergo surgery.

Hello everyone, I'm new to the forum and wanted to pick your brains on a few things.
I’ve been dealing with this esophageal issue for a couple of years now. I have significant trouble swallowing—whether it’s solid food or something softer—and I can’t even manage to drink water normally. Once I hit a certain number of bites, everything seems to "pile up," triggering an intense spasm. I get this sharp pain in my chest, and my immediate fix is to chug three or four glasses of water as fast as possible just to force everything down. Once that happens, the discomfort finally subsides. I was wondering if there is anything specific you all would recommend trying, or if I should just go straight to a specialist. Thanks in advance.

Laura Gray50 said:Hello everyone, I'm new to the forum and wanted to pick your brains on a few things.
I’ve been dealing with this esophageal issue for a couple of years now. I have significant trouble swallowing—whether it’s solid food or something softer—and I can’t even manage to drink water normally. Once I hit a certain number of bites, everything seems to "pile up," triggering an intense spasm. I get this sharp pain in my chest, and my immediate fix is to chug three or four glasses of water as fast as possible just to force everything down. Once that happens, the discomfort finally subsides. I was wondering if there is anything specific you all would recommend trying, or if I should just go straight to a specialist. Thanks in advance.

Are you experiencing any other symptoms?
Listen, you need to contact your primary care doctor immediately. Get your blood work done and based on those clinical indicators, schedule a GI specialist for an evaluation.

Can someone please help me out here? A few days ago, I had a bout of supraventricular tachycardia just from bending over. It felt like my stomach thudded a couple of times, and then my heart went completely haywire. Before that, I dealt with some acute pharyngitis that left my throat feeling raw and stinging. Following that tachycardia episode, I started getting this tightness in my throat—it feels like I’m trying to swallow thick gum. Every time I swallow, there's this pulling sensation stretching all the way down my esophagus. Now, eating solid food is a struggle because I get this terrifying sensation that a bite is getting stuck in my chest, which is pretty painful. About six months ago, I had an EKG and an endoscopy covering my esophagus, stomach, and duodenum. Everything came back fine, except for an elongated stomach. Honestly, I'm terrified to eat because of that sensation, and after reading too much online about esophageal cancer, I'm spiraling. Has anyone else dealt with these exact symptoms? Would doing another endoscopy actually be worth it at this point?

driftinglynx52 said:Can someone please help me out here? A few days ago, I had a bout of supraventricular tachycardia just from bending over. It felt like my stomach thudded a couple of times, and then my heart went completely haywire. Before that, I dealt with some acute pharyngitis that left my throat feeling raw and stinging. Following that tachycardia episode, I started getting this tightness in my throat—it feels like I’m trying to swallow thick gum. Every time I swallow, there's this pulling sensation stretching all the way down my esophagus. Now, eating solid food is a struggle because I get this terrifying sensation that a bite is getting stuck in my chest, which is pretty painful. About six months ago, I had an EKG and an endoscopy covering my esophagus, stomach, and duodenum. Everything came back fine, except for an elongated stomach. Honestly, I'm terrified to eat because of that sensation, and after reading too much online about esophageal cancer, I'm spiraling. Has anyone else dealt with these exact symptoms? Would doing another endoscopy actually be worth it at this point?

1. How can you be certain it was SVT?
2. Why was the initial gastroduodenal X-ray even ordered in the first place?
3. You need to contact your primary care physician. Based on your clinical symptoms, they will refer you to the right specialist or determine the next steps.

Sarah Vaughn94 said:Good afternoon, everyone,

I was wondering if any of you have gone ahead and moved forward with surgery yet? If so, I’m really curious about which specific procedure you opted for—since there are several different methods out there, I’d love to know what you actually had done and whether you’re feeling any better now. Also, have you reached a point where you can go back to eating everything again?

I was diagnosed with AHALAZIJA seven years ago. Right after finding out, I had a dilation... but the symptoms came right back after five days. Then I went in for another one, and I only felt okay for three days. After three dilations, they decided (🤣) I needed surgery. I had the operation six years ago. Even a month after the surgery, I didn't feel any different. I couldn't even swallow liquids properly. The surgeon told me he performed the procedure and that it *had* to be fine, and that I was just imagining things. I just looked at him, said thanks, and walked out. A couple of months later, I was back in Chicago for another dilation, where the doctor told me I'd basically have to deal with these damn dilations for the rest of my life because that's just how it is.

They put me under for laparoscopic surgery, but once they started, they realized the narrowing was too severe, so they had to make a full incision down my abdomen instead.

Lately, swallowing has been getting harder again, whether it's solid food or liquids. The chest pain is back, too. This might sound a little silly, but I've been making these noises that really bother me. They told me it's just air coming up from my stomach. It's been happening more and more often lately.

Hi,
I was diagnosed with AHALAZIJA about a year ago, so I went in for balloon dilation at a clinic in Chicago under Dr. Pulanić... which honestly didn't help at all. My symptoms haven't budged (it's hard to swallow anything thick or solid, I get sharp pains in my chest, and I deal with acid reflux into my windpipe at night, causing coughing...) but the doctor decided after the procedure that since the X-ray looked fine, I don't need any more dilations. It feels like they're totally ignoring the fact that my symptoms actually got worse... I even ended up on antibiotics recently for some bronchitis/lung inflammation, which I'm pretty sure was caused by that nightly reflux where food residue from dinner ends up in my lungs and I have to cough it out.
I'm really not sure what my next move should be... especially since I've been reading that these balloon dilations might not work or only offer short-term relief. Are there any alternative options out there, maybe acupuncture... or some way to get my esophagus working properly again? If anyone has any advice, I'd really appreciate it! :-)

Amy Ross5 said:Hi,
I was diagnosed with AHALAZIJA about a year ago, so I went in for balloon dilation at a clinic in Chicago under Dr. Pulanić... which honestly didn't help at all. My symptoms haven't budged (it's hard to swallow anything thick or solid, I get sharp pains in my chest, and I deal with acid reflux into my windpipe at night, causing coughing...) but the doctor decided after the procedure that since the X-ray looked fine, I don't need any more dilations. It feels like they're totally ignoring the fact that my symptoms actually got worse... I even ended up on antibiotics recently for some bronchitis/lung inflammation, which I'm pretty sure was caused by that nightly reflux where food residue from dinner ends up in my lungs and I have to cough it out.
I'm really not sure what my next move should be... especially since I've been reading that these balloon dilations might not work or only offer short-term relief. Are there any alternative options out there, maybe acupuncture... or some way to get my esophagus working properly again? If anyone has any advice, I'd really appreciate it! :-)

It would be helpful to see the test results from both before and after the procedure. Also, could you go into more detail about this "pneumonia" you mentioned? What medications are you currently taking, and what were you on previously?

Pre-op tests—X-rays, endoscopy, and esophageal manometry—all pointed toward AHALAZIJA. From what I gathered, the manometry showed a low-pressure lower esophageal sphincter and ineffective peristalsis, which is actually somewhat atypical for achalasia. After they performed the cardia disruption (which was done because the radiologist concluded it was achalasia), there was zero improvement. They also didn't find any other underlying issues, like neurological or myological conditions, that would explain the weak peristalsis. Following that, I was prescribed Reglan, but it didn't help at all; if anything, it made things worse because I started having more frequent nighttime regurgitation into my trachea. At my last checkup, they just recommended eating soft foods in smaller, more frequent meals and taking Controloc as needed... and then they scheduled me for an 18-month follow-up???
Regarding the lung/bronchial inflammation... after some heavy coughing, labored breathing, and a fever lasting four days, I went to the ER. They diagnosed me with a respiratory infection and prescribed Azithromycin (500mg once a day for three days), which cleared up the symptoms. Now, I'm wondering if that's totally unrelated to the achalasia, or if it's tied to it—specifically this coughing and spitting up mucus and food during the night (I should mention this used to happen maybe once a month, then weekly, but lately, it's happening every single night)
I hope that clears things up a bit... and I'm really hoping for some advice... thanks in advance! :-)

vividsailor7 said:It would be helpful to see the test results from both before and after the procedure. Also, could you go into more detail about this "pneumonia" you mentioned? What medications are you currently taking, and what were you on previously?

Amy Ross5 said:Pre-op tests—X-rays, endoscopy, and esophageal manometry—all pointed toward AHALAZIJA. From what I gathered, the manometry showed a low-pressure lower esophageal sphincter and ineffective peristalsis, which is actually somewhat atypical for achalasia. After they performed the cardia disruption (which was done because the radiologist concluded it was achalasia), there was zero improvement. They also didn't find any other underlying issues, like neurological or myological conditions, that would explain the weak peristalsis. Following that, I was prescribed Reglan, but it didn't help at all; if anything, it made things worse because I started having more frequent nighttime regurgitation into my trachea. At my last checkup, they just recommended eating soft foods in smaller, more frequent meals and taking Controloc as needed... and then they scheduled me for an 18-month follow-up???
Regarding the lung/bronchial inflammation... after some heavy coughing, labored breathing, and a fever lasting four days, I went to the ER. They diagnosed me with a respiratory infection and prescribed Azithromycin (500mg once a day for three days), which cleared up the symptoms. Now, I'm wondering if that's totally unrelated to the achalasia, or if it's tied to it—specifically this coughing and spitting up mucus and food during the night (I should mention this used to happen maybe once a month, then weekly, but lately, it's happening every single night)
I hope that clears things up a bit... and I'm really hoping for some advice... thanks in advance! :-)

This case is definitely atypical. The hallmark feature of a manometry reading for achalasia is either an absent or incomplete relaxation of the LES. Furthermore, the resting pressure is usually elevated, sitting around 30-40mmHg.
Normal is 10-20mmHg, plus there's aperistalsis.
Look, unless you transcribe the results for me—or better yet, send over the actual images—it’s nearly impossible for me to give you anything concrete or coherent.

vividsailor7 said:This case is definitely atypical. The hallmark feature of a manometry reading for achalasia is either an absent or incomplete relaxation of the LES. Furthermore, the resting pressure is usually elevated, sitting around 30-40mmHg.
Normal is 10-20mmHg, plus there's aperistalsis.
Look, unless you transcribe the results for me—or better yet, send over the actual images—it’s nearly impossible for me to give you anything concrete or coherent.

Hi, I tried to snap a photo but I keep getting an upload error, probably because the file size is too big. If I shrink the image, it becomes unreadable, so I'll just transcribe it here...

May 02, 2011 Medical History

For the last year and a half, they've had epigastric pain, dysphagia with liquids, and now even with solids, accompanied by regurgitation. Because of this, they were seen this past April by Dr. Rotkvić, who diagnosed AHALAZIJA based on endoscopic and radiological exams.
The clinical presentation and those tests point directly to that condition.
IMPRESSION
Prior to cardiac dilation, please perform esophageal manometry and a barium swallow at the Holy Spirit medical center under prof. Jurčić

September 05, 2011
HISTORY
Patient presents with manometry results that are non-specific: hypotensive lower esophageal sphincter and predominantly ineffective peristaltic activity.
RECOMMENDATIONS
Given these findings (X-ray, EGD, and esophageal manometry) along with the persistent dysphagia, I recommend hospitalization for further testing and a decision regarding cardiac dilation.

September 05, 2011
DIAGNOSIS

They were admitted to our facility on September 15, 2011, where we performed cardiac dilation using a non-expansive balloon—yet despite this, the dysphagia persists.
IMPRESSION
Please order an esophageal X-ray and a contrast swallow study; after reviewing the results, we will decide whether to repeat the procedure.

January 16, 2012
HISTORY

Presenting with swallowing study and esophagram results from December 23, 2011 showing a widened esophageal lumen and hypotonia; emptying is difficult through the distal segment, which has normal width and regular mucosal fold contours.
Manometry findings from May 2011: hypotensive lower esophageal sphincter and ineffective peristaltic activity.
Cardiac dilation was performed at our facility on September 15, 2011 (the radiologist's conclusion was AHALAZIJA). We suggested starting Controloc.

IMPRESSION
Considering the X-ray findings, the inconclusive manometry, and the poor response to cardiac dilation, we suggest using prokinetics (cisapride, domperidone, metoclopramide). Since we carry Reglan, we suggest attempting to improve peristalsis with metoclopramide (Reglan) 3x daily. Follow-up in 1 month.

February 27, 2012
History
Reglan isn't working, nor has there been any improvement. We recommend a soft food diet with more frequent, smaller meals. In case of heartburn, take Controloc 40 mg as needed.
We recommend an endoscopic follow-up in 18 months. However, if symptoms persist (dysphagia, increased heartburn), come in sooner.

I spent two years dealing with some pretty brutal dysphagia, basically living off a feeding tube... but thanks to a speech therapist over at the Mayo Clinic, I’m finally back to eating on my own again

Hi there, I have a quick question for the group. To be honest, I’ve been dealing with the exact same symptoms as everyone else here for about two years now. I've actually had two different X-rays of my esophagus, and both times the results came back perfectly normal. It makes me wonder—is it actually possible for a narrowing to be completely invisible on an X-ray, even if the disease is still there?