Imagine sitting down for a meal and finding that no matter how carefully you chew, the food just will not go down. It sits at the base of your throat, refusing to move, sometimes coming back up. This is the reality for people living with achalasia, a rare but serious condition that affects the esophagus and makes eating feel like a battle.
What causes achalasia is a question that many patients and their families ask, and the answer involves a complex mix of nerve damage, immune responses, and, in some cases, other underlying diseases. In this blog, we are going to break it all down in a way that actually makes sense, just clear information to help you understand what is happening in your body.
What Is Achalasia?
Achalasia is an esophageal motility disorder, meaning it affects the ability of the esophagus to move food down toward the stomach. The esophagus is a muscular tube, and it relies on coordinated muscle contractions (called peristalsis) to push food downward. In people with achalasia, two things go wrong:
- Impaired esophageal peristalsis means the muscle contractions do not work properly, and
- Lower esophageal sphincter dysfunction means the valve at the bottom of the esophagus does not relax the way it should.
The result is that food and liquids get stuck, leading to progressive swallowing difficulty that worsens over time if not treated.
The Root Cause: Nerve Damage in the Esophagus
At the core of most cases of achalasia is degeneration of esophageal nerves, specifically the loss of nerve cells in a network called the myenteric plexus, which controls the muscular activity of the esophagus. When these nerve cells are damaged or destroyed, the muscles of the esophagus lose their coordination, and the lower esophageal sphincter fails to open properly during swallowing.
Esophageal nerve degeneration is gradual, which is why symptoms often start mildly and worsen over months or even years. It also explains why chronic swallowing problems tend to be the hallmark complaint and why food getting stuck in the esophagus becomes an increasingly common experience.
Primary Achalasia Causes (When No External Trigger Is Found)
In most patients, achalasia is considered idiopathic, meaning no clear external cause can be identified. This is called primary achalasia. Primary achalasia causes are believed to involve an autoimmune process.
The autoimmune causes of achalasia theory suggests that the body’s immune system mistakenly attacks the nerve cells in the esophagus, gradually destroying them. This autoimmune reaction may be triggered by a viral infection in genetically susceptible individuals, though the exact mechanism is still being studied. Neurological disorders affecting esophageal function are central to why the condition develops the way it does.
The causes in primary cases are also thought to involve a combination of genetic predisposition and environmental triggers, which is why it can run in families, though this is not common.
Secondary Achalasia Causes (When Another Condition Is Responsible)
Secondary achalasia causes are those linked to another identifiable condition. The most important and common secondary cause is Chagas disease, a parasitic infection caused by Trypanosoma cruzi. This parasite directly attacks and destroys the nerve cells in the myenteric plexus, leading to causes of esophageal motility failure that mimic primary achalasia.
Other secondary esophageal achalasia causes include certain cancers (particularly tumors near the esophagogastric junction), amyloidosis, and sarcoidosis. When cancer is the underlying cause, it is referred to as pseudoachalasia; it looks like achalasia but is actually driven by a tumor affecting the esophageal valve. This is why a thorough diagnostic workup is essential to determine what causes achalasia.
Achalasia Risk Factors: Who Is More Likely to Develop It?
While achalasia can affect anyone, certain achalasia risk factors make some people more vulnerable. These include:
- Age: Achalasia most commonly appears in people between the ages of 25 and 60, though it can occur at any age. It is relatively rare in children.
- Autoimmune conditions: People who already have other autoimmune disorders may have a higher likelihood of developing the autoimmune-driven nerve damage associated with primary achalasia.
- Geographical exposure: In regions where Chagas disease is endemic (particularly parts of Latin America), the risk of secondary achalasia from parasitic infection is higher.
- Family history: Although rare, familial cases of achalasia have been documented, suggesting a possible genetic component.
Esophageal achalasia causes in terms of risk are not fully predictable, which is why the condition is often diagnosed late, sometimes years after symptoms begin.
What Does Achalasia Feel Like?
Understanding what causes achalasia also helps explain the symptoms. Because the esophagus cannot contract properly and the lower sphincter does not open, patients experience:
- Difficulty swallowing (dysphagia): Both solids and liquids, which is a distinguishing feature from other swallowing disorders.
- Regurgitation: Food or liquid comes back up, especially at night, which can sometimes be inhaled into the lungs.
- Chest pain: Caused by the pressure of food sitting in the esophagus.
- Weight loss: Eating becomes such a struggle that many patients unintentionally reduce their food intake.
These swallowing disorder causes are directly linked to the esophageal muscle dysfunction and nerve damage at the heart of the condition.
Diagnosis and Treatment at BMI Surgicals
Diagnosing achalasia requires specific tests, most importantly, esophageal manometry (which measures muscle pressure and coordination) and a barium swallow study. Endoscopy is also done to rule out esophageal blockage causes related to structural problems or cancer.
Once achalasia is confirmed, treatment focuses on relieving the obstruction at the lower esophageal sphincter. At BMI Surgicals, we offer minimally invasive surgical options, including laparoscopic Heller myotomy, a procedure that cuts the tight muscle fibers of the lower esophageal sphincter to allow food to pass more easily. We also offer peroral endoscopic myotomy (POEM), a newer, incision-free approach with excellent outcomes.
Our experienced team understands that difficulty swallowing reasons go beyond just physical discomfort; they affect nutrition, quality of life, and emotional well-being. We are here to offer a complete, compassionate care plan.
Final Thoughts
Achalasia is a complex condition, but understanding its causes empowers you to seek the right help at the right time. Whether it is nerve degeneration, an autoimmune response, or a secondary condition like Chagas disease, the outcome for most patients with achalasia is significantly improved with proper treatment.
If you or someone you know is dealing with persistent difficulty swallowing, food getting stuck, or chest discomfort after eating, do not dismiss it. These symptoms deserve investigation. The team at BMI Surgicals is ready to evaluate your condition and help you find lasting relief.