Achalasia is a rare esophageal motility problem that may coexist with a hiatal hernia. Both achalasia and hiatal hernia are associated with heartburn. The treatment in your case consists of hiatal hernia repair with Heller myotomy and fundoplication. Hiatal hernia is uncommon in patients with achalasia for reasons not known. Age, sex, symptoms, and results of esophageal manometry were not significantly different in those with hiatal hernia. Finally, the presence of hiatal hernia is not a contraindication to treatment of achalasia.