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Originally published August 5, 2026
Last updated August 5, 2026
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Achalasia is a swallowing disorder that affects only about one in 100,000 to 200,000 people. But for those who experience its symptoms, the effects can be deeply unpleasant and debilitating.
One 31-year-old Southern California man began experiencing symptoms in late 2024 after eating homemade arroz con pollo, one of his favorite dishes.
What happened next was baffling: Almost as soon as he finished his meal, he threw it up. He had not felt at all queasy after eating, and the food was fresh, so what happened didn’t seem to make sense. If anything, he thought he had eaten too quickly.
Strangely, however, over the next few weeks, throwing up after meals became increasingly frequent; before long, it became the norm.
Because the 31-year-old didn’t know how quickly vomit might come on, he needed to be near a bathroom or sink whenever he ate or drank. He stopped eating with friends and coworkers to avoid potential embarrassment.
“It wasn’t that long before I felt like I couldn’t keep anything down,” the patient says. “It started to influence pretty much every decision I made about my day.”
In early 2025, he saw two different gastroenterologists to try controlling the vomiting and heartburn that developed in tandem. One suggested he might have dysphagia, or difficulty swallowing. Both sent him home with prescriptions to treat heartburn, which brought him no relief.
As the weeks and months went on, his problem began to take a toll on him. Not only had he stopped socializing; he also stopped working out because he feared the exertion might cause him to pass out.
He was dropping weight fast, shedding 40 pounds in only a few months, and was dealing with frequent hunger and thirst.
Though frustrated that he hadn’t gotten any relief from treatments, the 31-year-old followed the encouragement of friends and family to keep searching for answers.
He made an appointment with John C. Lipham, MD, a gastrointestinal surgeon with the USC Digestive Health Institute, part of Keck Medicine of USC, who treats patients at locations including Keck Medicine of USC – Newport Beach. Lipham was able to tell the 31-year-old that he had achalasia.
Achalasia is a condition in which the muscles of the esophagus, which typically push food and liquid into the stomach, no longer function. The lower esophageal sphincter, a muscle at the bottom of the esophagus that usually opens to allow food to pass from the esophagus and into the stomach, closes shut in people with achalasia.
Due to the malfunctioning of these muscles, food gets stuck in the esophagus and is ultimately regurgitated.
Achalasia can strike at any age and, while the root cause is unknown, researchers believe viral infections or autoimmune issues damage the nerves in the esophagus.
Lipham notes that achalasia can have very serious consequences for some people.
Regurgitating food can lead to aspiration pneumonia and lung infections, and because it can happen during sleep, achalasia can also lead to choking. It is also relatively common for people to become severely malnourished.
“Achalasia is pretty rare and hard to diagnose because there are other disorders that look similar,” Lipham says. For instance, symptoms include dysphagia for both solids and liquids, regurgitation of bland material, foamy regurgitation, occasional heartburn, pneumonia and weight loss. Patients with any complaints of dysphagia or heartburn not controlled by medications should be referred to a specialist for evaluation, he adds.
Additionally, achalasia can only be diagnosed with highly specialized testing like high-resolution esophageal manometry or an endoluminal functional lumen imaging probe. “Many gastroenterologists don’t have the equipment to diagnose this problem, but we have advanced diagnostic capabilities here at Keck Medicine,” Lipham says.
At the 31-year-old’s visit with Lipham, he underwent a pair of tests. The first test, high-resolution esophageal manometry, involved inserting a catheter through the patient’s nose, which allowed Lipham to observe what happened in the esophagus while the patient attempted to eat and drink.
The second test used a different type of catheter — this one with a balloon on it — called an endoluminal functional lumen imaging probe. This probe evaluates how well the esophagus is functioning by measuring dimensions and its pressure.
Lipham adds that once achalasia patients receive a proper diagnosis, there are good treatment options. Some patients benefit from medication — such as calcium channel blockers like diltiazem, or nitrates like nitroglycerin — but Lipham suggested that the 31-year-old be treated surgically, which is recommended for younger patients and older adults who are healthy enough for surgery.
He recommended a laparoscopic or robotic Heller myotomy during which the sphincter muscle at the end of the esophagus is cut/loosened to relieve the functional obstruction. “The treatment is relatively simple and makes things much better for these patients almost immediately,” Lipham says.
Lipham performed the minimally invasive procedure with the assistance of a robot. Using small instruments and a laparoscope inserted into the patient’s abdomen through several tiny incisions, he cut back the muscles in the lower esophageal sphincter.
He also preemptively addressed a potential side effect of the surgery. The procedure keeps the lower esophageal sphincter — which sits at the bottom of the esophagus — open, which can result in gastroesophageal reflux. To prevent this potential side effect, Lipham then performed a partial fundoplication to wrap the upper part of the stomach around the esophagus to create an anti-reflux valve.
The patient had to stick with a liquid diet for a few days after his procedure to allow his wounds to heal. But even so, he immediately knew that things had changed for the better.
“I could only eat Jell-O and soup, but I could definitely feel the difference right away,” he says. “I knew it wasn’t getting stuck and that things were finally going down again and making it into my stomach.”
When he was finally given the green light to eat solid food, he made a beeline for his neighborhood In-N-Out. Soon, almost as quickly as he had shed the 40 pounds, he put weight back on and began to look and feel like his old self.
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