The Bottom Line: At this time there is no cure for esophageal achalasia. The only available therapeutic options are to loosen the lower esophageal sphincter and treat symptoms. Pharmacological management such as smooth muscle relaxation plays a minor role in treatment but the efficacy is usually unsatisfactory with intolerable side effects.
Chuah, Seng-Kee, et al. “2011 update on esophageal achalasia.” World Journal of Gastroenterology 18.14 (2012):1573-1578.
Achalasia involves the selective loss of inhibitory neurons in the myenteric plexus, which leads to production of vasoactive intestinal polypeptide, nitric oxide, and inflammatory infiltrate responsible for abnormal lower esophageal sphincter dysfunction. An unopposed excitation of the lower esophageal sphincter causes its dysfunction or failure to relax in response to swallowing. The clinical presentations include dysphagia for both liquids and solids, regurgitation may be severe enough to produce pulmonary complications such as cough or aspiration pneumonia. Weight loss usually occurs as a result.