Dysphagia invariably worsens when an antireflux procedure without myotomy is performed in achalasia for a mistaken diagnosis of gastroesophageal reflux disease. There is little in the medical literature, however, to guide its optimal management. I describe two patients in whom pneumatic dilatation provided symptomatic improvement. This complication is entirely avoidable if the clinician pays careful attention to the clinical features of the case (especially the history and barium esophagram) and performs an esophageal motility study.