DEAR READER: The esophagus carries food from the mouth to the stomach. Achalasia is a disorder of the lower muscular ring where the esophagus and stomach meet that makes the body less effective in moving food. This occurs in part because the stomach does not relax as it should during the normal course of swallowing, and it is why you received a Botox injection.

Symptoms include weight loss, chest pain that may radiate to the back, neck and arms (similar to a heart attack), difficulty swallowing both solids and liquids, coughing and reflux. Diagnosis is made through esophageal manometry, a test to measure the pressure inside the lower part of the esophagus. A barium esophagogram or an upper GI X-ray will reveal any esophageal enlargement with narrowing at the bottom, as well as the absence of peristalsis (rhythmic smooth muscle contractions that propel food through the digestive tract).

Therapy often consists of either botulinum (Botox) injections to prevent spasms, widening of the lower sphincter or surgery. You have already undergone two of the three common treatment approaches. Perhaps the next step is to speak with your physician regarding surgery, or request a second opinion. Achalasia isn’t preventable; however, treatment can go a long way toward reducing complications.