The cause of achalasia is unknown, but anxiety and emotional tension seem to aggravate the condition and precipitate attacks. As a result of this aspiration the patient may develop pneumonia or atelectasis.
Diagnosis is confirmed by manometric readings, which document motor dysfunction.
Conservative treatment of mild cases consists of advising the patient to eat a bland diet that is low in bulk. Very large meals should be avoided and all foods should be eaten slowly with frequent drinking of fluids during the meal. To reduce the possibility of aspiration of esophageal contents during sleep, the patient is instructed to sleep with the head and shoulders elevated. A nonsurgical method for treating resistant cases is repeated dilation of the esophageal sphincter by means of a bougie or by a pneumatic bag that is guided into place under x-ray visualization. As a last resort surgical intervention may be necessary.