Achalasia
Cardia

What is Achalasia cardia?

The lower end of the esophagus does not open up(relax) when food comes in, resulting in a block in the lower end of the food pipe(food stuck there).The motility (propulsion of food) in the body of the esophagus is also not there. So, food starts getting accumulated in the food pipe, causing it to dilate over time.

What are the common symptoms?

Patients with achalasia experience symptoms that gradually worsen over time.

Typical symptoms include:

Difficulty in swallowing (dysphagia) – more for liquids than solids
Sensation of food sticking in the throat or chest
Regurgitation of undigested food, sometimes even days later
Weight loss and malnutrition
Vomiting of retained food
Night-time coughing or choking, especially when lying down
Heartburn, burping, or chest pain
Respiratory symptoms like coughing, wheezing, hoarseness, or bronchitis due to aspiration of food into the lungs

Which Gender Is more affected by Achalasia?

Achalasia affects both men and women equally, most commonly between the ages of 20 and 50 years. It is rare in children, accounting for only 2–5% of cases.

What causes Achalasia Cardia?

Achalasia occurs due to damage or loss of nerve cells (ganglia) in the lower esophagus and the lower esophageal sphincter (LES).

Autoimmune reactions (body attacking its own nerve cells)
Viral infections
Genetic predisposition

These lead to the sphincter remaining tightly closed and the esophagus losing its ability to push food downward.

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How is Achalasia diagnosed?

Diagnosis involves a stepwise approach to confirm the condition and rule out other causes of blockage.

Clinical evaluation and symptom scoring (Eckardt score)
Upper GI endoscopy – to rule out cancer or other mechanical obstruction
High-Resolution Esophageal Manometry (HRM) – gold standard for diagnosis; measures muscle activity and identifies achalasia subtype
Barium swallow X-ray – shows dilated esophagus with narrowing at the lower end (“bird-beak” appearance)
Multidisciplinary discussion to select the best treatment approach (POEM, Heller’s Myotomy, Balloon Dilation, or Botox injection)

What are the treatment options for Achalasia Cardia?

The main goal of treatment is to relieve swallowing difficulty, prevent food stagnation, and reduce complications.

Surgical Treatment

Laparoscopic Heller’s Cardiomyotomy with Fundoplication (Gold Standard)

The muscle fibers at the lower end of the esophagus are cut to allow food passage.
A fundoplication (wrapping part of the stomach around the esophagus) is performed to prevent reflux.
Offers excellent long-term relief from symptoms.

Esophagectomy

Removal of the entire esophagus in advanced, long-standing cases (sigmoid or megaesophagus).

Endoscopic Treatment

1. POEM (Peroral Endoscopic Myotomy)

Performed through endoscopy; muscle fibers are cut internally.
Effective but technically demanding, with risks such as infection, pneumothorax, or perforation.
Long-term results are still under evaluation.
Severe reflux symptoms occur post procedure

2. Balloon Dilatation (Pneumatic Dilation)

A balloon is inserted and inflated at the LES to stretch it open.
Provides short-term relief; repeat sessions often needed.
Suitable for patients unfit for surgery.

3. Botulinum Toxin (Botox) Injection

Temporarily relaxes the LES by blocking nerve signals.
Offers short-term relief (3–12 months) and often used in elderly or unfit patients.

4. Stent Implantation

Considered for patients who are not suitable for surgery or endoscopic myotomy.

Medication

Medicines are usually prescribed when patients are not fit for or refuse surgical/endoscopic therapy.

Calcium channel blockers, nitrates, and proton pump inhibitors (PPIs) may help reduce pressure and control reflux.
However, they provide only temporary relief and are less effective than surgery or dilation.

Frequently Asked Questions (FAQs)

What happens if Achalasia Cardia is left untreated?

Untreated achalasia can lead to:

Severe malnutrition and weight loss
Aspiration pneumonia and respiratory infections
Esophageal cancer (increased long-term risk)
Massive esophageal dilatation (end-stage “sigmoid” esophagus)
In rare cases, acute respiratory failure

Can achalasia be cured?

Current treatments relieve symptoms effectively, but restoring normal peristaltic movement of the esophagus is uncommon.

Surgery (Heller’s or POEM) provides long-lasting relief from swallowing difficulty.
Balloon dilation or Botox injections offer temporary relief and may need repetition.

How quickly will I improve after treatment?

Recovery depends on the chosen treatment:

After Heller’s Myotomy, swallowing usually improves within a day, confirmed by a gastrografin swallow test.
Balloon dilatation often gives rapid improvement but may need multiple sessions.
Botox injections relieve symptoms for a few months but require repeat treatments.

Are there risks to treatment?

Each treatment carries specific risks:

Reflux after POEM
Perforation or bleeding (rare)
Recurrence of symptoms over time
Your medical team at Best Gastro Care Center will explain the benefits, risks, and expected recovery for your chosen treatment plan.

What is Laparoscopic Heller’s Cardiomyotomy with Partial Fundoplication?

It is a minimally invasive surgical procedure done through 3–4 small holes using laparoscopy. The non-relaxing muscles at the lower end of the food pipe (esophagus) are cut to relieve the blockage. A partial fundoplication (wrapping part of the stomach around the lower esophagus) is added to prevent food and acid from refluxing back into the esophagus.

How long is the hospital stay after the surgery?

The hospital stay is usually 2–3 days.

Is it a major surgery?

Yes. It is a major surgery performed under general anesthesia. It is a technically demanding procedure that should be done by experienced gastrointestinal surgeons.

How is the symptom relief after surgery?

Symptom relief is usually dramatic. Difficulty in swallowing improves significantly, patients can eat normally, regain lost weight, and become healthy again. Heartburn, cough, and wheezing caused by reflux also get completely relieved after surgery.

How long does it take for patients to have symptom relief?

Symptom relief is almost immediate.

On the day after surgery, a dye test (contrast swallow study) is done to confirm that the blockage is relieved. Patients usually feel the improvement right away.

Which is better — POEM or Laparoscopic Heller’s Cardiomyotomy?

Laparoscopic Heller’s Cardiomyotomy is considered the gold standard treatment for achalasia cardia. It not only relieves the blockage but also helps prevent reflux due to the added fundoplication.

In contrast, POEM (Peroral Endoscopic Myotomy) carries a higher risk of perforation (hole) in the esophagus, which can be life-threatening, and has a 100% chance of reflux after the procedure.

At The Best Gastro Care Centre

Your Health, Our Priority

Achalasia Cardia: Expert Care and World-Class Treatment

Our expert team provides world-class treatment for Achalasia Cardia and other gastrointestinal diseases using advanced techniques and compassionate care. We focus on restoring your ability to swallow and improving your quality of life.

📞 Book your appointment today to consult our specialist gastro for timely diagnosis and treatment of Achalasia Cardia.