GERD vs. Achalasia: Understanding the Differences & Risks

Gastroesophageal reflux disease usually comes from a weakened lower esophageal sphincter. Achalasia results when the nerves that control esophageal contractions malfunction, causing the sphincter not to relax normally. Gastroesophageal reflux disease, if untreated, can result in an abnormal condition called Barrett's Esophagus, which is precancerous. Achalasia may lead to regurgitating undigested food while sleeping, which could be inhaled into the lungs and cause a lung abscess or pneumonia.

Symptoms

• Gastroesophageal reflux symptoms are predominately acid indigestion (heartburn), although frequent coughing, wheezing, sore throat, hoarseness and other symptoms may be present. Achalasia symptoms include difficulty swallowing, non-acidic regurgitation and nighttime coughing.

Identification

• Usually, the symptoms are enough to identify gastroesophageal reflux disease, although more tests such as an endoscopy may be done. An X-ray of the esophagus during swallowing will show an absence of movement (peristalsis) if achalasia exists.

Considerations

• Acid from untreated reflux may cause a stricture around the lower esophageal sphincter, making swallowing increasingly difficult. Although achalasia causes swallowing problems as well, endoscopic examination can distinguish between the two.

Treatment

• Reflux treatments range from elevating the head of the bed 6 inches, dietary options (avoiding chocolate, fats and highly acidic foods), antacids or stronger drugs. Achalasia is treated with drugs to relax the lower esophageal sphincter, mechanical dilation or botulism toxin injections.

Warning

• Esophageal spasm, where the movement of the esophagus as a person swallows becomes nonpropulsive may be confused with these other esophageal conditions. Therefore, all problems connected with swallowing difficulties should be evaluated by a doctor.