Choking After Meals? How to Spot the Rare Condition Known as Achalasia

Many people suspect they have acid reflux when experiencing heartburn after meals. However, if symptoms persist despite medication and you frequently vomit at night, you may want to consider a rare condition called achalasia.

Achalasia is a disorder in which the lower esophageal sphincter fails to relax properly. This sphincter typically prevents stomach contents and acid from flowing back into the esophagus.

While uncommon, achalasia can cause severe symptoms. When nerve cells in the esophageal sphincter and lower esophagus malfunction, the regular peristaltic contractions that push food down to the stomach become impaired, causing food to get stuck in the esophagus.

As a result, people with achalasia may choke when lying down after eating dinner, often experiencing violent vomiting, especially at night. They may also feel chest pain and discomfort behind the breastbone, making it difficult to eat.

Patients might vomit undigested food during or shortly after meals. These symptoms can significantly disrupt eating habits and lead to weight loss.

Perhaps most concerning is that leaving achalasia untreated for over a decade can increase the risk of esophageal cancer by 10 to 30 times. While not typical, esophageal cancer is deadly, with a five-year survival rate of only about 50%.

This increased cancer risk arises from food remaining in the esophagus, causing inflammation that can lead to squamous cell carcinoma.

Moreover, when food remains in the esophagus, bacteria can ferment it, producing carcinogenic nitrosamines. Precancerous changes have been observed in some achalasia patients.

The exact cause of achalasia remains largely unknown. However, experts believe it occurs when nerve cells controlling muscle movement in the esophagus degenerate, impairing its ability to move food downward.

Secondary achalasia can also develop from conditions like lymphoma or certain infections that affect the esophageal muscles.

Once diagnosed, damaged nerve cells cannot be regenerated. Therefore, treatment focuses on managing symptoms and preventing complications.

Treatment options include medications, Botox injections, balloon dilation, and a minimally invasive procedure called peroral endoscopic myotomy (POEM). POEM involves making an incision in the thickened muscle of the esophagus using an endoscope inserted through the mouth.