Many RefluxMD members ask us about common symptoms that include regurgitation of undigested food, difficulty swallowing, and chest pain or heartburn. They are confident that the cause is acid reflux — but is that correct? Without actual testing by a GERD expert, it could be something very different, including an esophageal mobility disorder called achalasia. This video from the Cleveland Clinic provides a great overview of the differences between acid reflux symptoms and achalasia symptoms.
Video overview differentiating achalasia from GERD
If you have trouble viewing the video, click here to watch it on YouTube.
Summary of Video – achalasia symptoms vs. acid reflux symptoms
How achalasia different from acid reflux?
Achalasia is a relatively uncommon condition that is often mistaken for acid reflux, according to Dr. Siva Raja of the Cleveland Clinic’s Department of Thoracic Surgery. “It is a disease that effects the esophagus, specifically the junction between the esophagus and the stomach called the lower esophageal sphincter (LES). Achalasia is a condition where the valve (LES) fails to open” and is often misdiagnosed as acid reflux, a more common condition. Proper diagnosis to differentiate between the two conditions can be tricky “because it is difficult to tell when food is coming back up from the stomach or if food is just sitting there.” For people with achalasia, the LES fails to “contract in a normal fashion to propel food down” causing food to back up, which keeps them from “being able to eat normally.”
How achalasia is diagnosed
In this video, Dr. Raja explains what achalasia is and recommends the use of three medical tests that can be performed by a GERD expert when achalasia symptoms or GERD symptoms are in question:
Endoscopy. “Where they put a camera down through the mouth into the stomach to see if there are any other reasons why there would be a blockage such as cancer, stricture, or narrowing from acid reflux.” If none of this is found, “but the valve appears tight or has high pressure, that is suggestive of achalasia.”
Barium esophagram. This is a non-invasive test that allows physicians to view the performance of the GI tract. The barium is swallowed, thus coating the GI tract, which then allows the physician to watch the contrast agent proceed through the esophagus, into the stomach, and into the small intestines. This allows the doctor to see several abnormalities such as blockage, stenosis or narrowing, inflammation and reflux from the stomach back into the esophagus.
Manometry. This test allows the physician to determine if muscle disorders exist in the esophagus, thus making it difficult to push food and liquids down into the stomach. Patients are asked to swallow a thin tube, and subsequent swallows then measure the contractions of the esophagus. This test can identify a lower esophageal sphincter that is not relaxing in response to swallowing, as well as weakness in the muscles surrounding the esophagus.
Proper diagnosis is key
Once achalasia symptoms are properly diagnosed, a GERD expert can effectively treat the underlying cause. Treatment can include diet and lifestyle changes, medications, pneumatic dilation, and surgery. However, the most important take-away from this discussion is that GERD-like symptoms can result from either an LES that is damaged and will not close or an LES that will not relax properly. A proper diagnosis is a critical step in determining the best treatment for your symptoms. For those with increasing symptoms that appear to be GERD, we always recommend those members schedule an appointment with a GERD expert.
For more on achalasia symptoms, diagnosis, and treatment, we suggest you visit the Cleveland Clinic patient education website.