What lifestyle modifications can I recommend to patients with achalasia to help alleviate their symptoms?

Lifestyle modifications for patients with achalasia focus on alleviating symptoms related to impaired oesophageal emptying and dysphagia. Patients are advised to eat smaller, more frequent meals to reduce oesophageal distension and improve comfort during swallowing. Avoiding large meals and eating slowly can help minimize symptoms. Elevating the head of the bed by 10–15 cm may reduce nocturnal regurgitation and aspiration risk by using gravity to aid oesophageal clearance. Patients should avoid lying flat soon after eating to prevent symptom exacerbation. Maintaining adequate hydration and consuming softer or liquid foods can ease swallowing difficulties. Smoking cessation and avoiding alcohol are recommended as these can worsen oesophageal irritation and motility. Weight management may be beneficial if obesity is present, as excess weight can exacerbate reflux symptoms. Stress management may also be helpful, as anxiety can worsen symptom perception. These lifestyle measures are extrapolated from expert consensus on managing oesophageal motility disorders and gastro-oesophageal reflux disease, given limited direct trial evidence in achalasia but supported by general principles in dyspepsia and reflux management ¹,⁴ (Slim and Williamson, 2023). Overall, lifestyle advice aims to reduce symptom burden and improve quality of life while awaiting or alongside definitive treatments such as pneumatic dilatation or myotomy.