Which symptom of achalasia tends to be the worst for patients?

Dysphagia for liquids tends to be the most distressing symptom for patients with achalasia. This condition involves a significant impairment of the esophagus's ability to move food and liquids down into the stomach due to dysfunction of the lower esophageal sphincter and loss of peristalsis.

As a result, many patients first present with difficulty swallowing solids, but it is often the inability to swallow liquids that causes greater concern and discomfort. Liquids are typically easier to consume, and when patients experience difficulty or pain in swallowing them, it can severely impact their ability to stay hydrated and nourished. This can lead to a more pronounced feeling of frustration and anxiety, as well as signs of dehydration.

Other symptoms like heartburn or regurgitation may occur, but they typically do not elicit the same degree of distress as the inability to consume liquids. The focus of patients’ complaints often centers around how these symptoms affect their day-to-day quality of life, with dysphagia for liquids emerging as particularly challenging due to its implications for hydration and nutrition.