What is achalasia cardia?

Achalasia cardia is a chronic motility disorder of the esophagus. This muscular conduit carries ingested material from the esophagus to the stomach, where the LES (lower esophageal sphincter, a circular muscle at the junction of the esophagus and stomach) remains closed during swallowing. The esophagus can no longer move food down in a synchronized way. The lower esophageal sphincter (LES), a circular muscle at the meeting point of the esophagus and stomach, fails to relax during swallowing. The esophagus loses its capacity to force food downward in a coordinated manner.

Food and beverages may become lodged in the esophagus rather than enter the stomach as a result of this malfunction. It eventually results in increasing difficulties swallowing and other digestive issues that might seriously interfere with day-to-day activities.

Why is the condition called “achalasia cardia”?

Greek words that indicate "failure to relax" are the source of the phrase "achalasia."

“Cardia” refers to the lower end of the esophagus near the stomach.

Together, achalasia cardia describes the failure of the lower esophageal sphincter to relax, a hallmark of the disease.

Which part of the digestive system is affected in achalasia?

Achalasia affects two main components:-

1. The esophageal body, which usually generates wave-like contractions (peristalsis)
2. The lower esophageal sphincter (LES), which opens during swallowing

In achalasia:-

• Peristalsis becomes weak or absent.
• LES pressure remains abnormally high

This dual dysfunction leads to obstruction of the food passage.

Is achalasia cardia a common disease?

Achalasia is considered rare, with an estimated incidence of 1–3 cases per 100,000 people per year. However, because early symptoms are subtle, many patients remain undiagnosed for years.

The disease:-

• It can occur at any age.
• Doctors test it between the ages of 30 and 60.
• Affects men and women equally

What causes achalasia cardia?

Although the precise cause of achalasia remains unknown, evidence strongly suggests that nerve cell degeneration in the esophagus wall, especially those involved in muscular relaxation, plays a role.

Among the suggested relevant elements are:-

• In rare instances, genetic susceptibility
• Viral infections cause immune-mediated damage.
• Autoimmune destruction of esophageal nerves

In some patients, achalasia-like symptoms may emerge from tumors near the gastroesophageal junction. This condition, called pseudoachalasia, must always be excluded during evaluation.

Is achalasia cardia inherited?

Achalasia is not usually inherited. Most cases occur sporadically. Very rarely, it may be associated with specific genetic syndromes, but this is uncommon.

What are the early symptoms of achalasia cardia?

Early symptoms often develop slowly and may be mistaken for common digestive problems. These include:-

• Difficulty swallowing solid foods
• Sensation of food sticking behind the breastbone
• Mild chest discomfort after meals
• Regurgitation of undigested food
• Heartburn symptoms that do not improve with antacids

Because symptoms are gradual, patients often adapt their eating habits unconsciously.

How do symptoms change as achalasia progresses?

As the disease advances, swallowing difficulty becomes more pronounced and affects both solids and liquids. Additional symptoms may include:-

• Frequent regurgitation, especially when lying down
• Night-time coughing or choking episodes.
• Chest pain unrelated to heart disease
• Persistent bad breath
• Unintended weight loss
• Fatigue and nutritional deficiencies

Can achalasia cardia cause breathing problems?

Yes. Retained food and liquids can enter the airway, leading to:-

• Chronic cough
• Recurrent chest infections
• Aspiration pneumonia
• Worsening asthma-like symptoms at night

These respiratory complications are common reasons patients seek medical care.

What complications can occur if achalasia is left untreated?

Untreated achalasia can lead to serious long-term complications such as:-

• Severe malnutrition and dehydration
• Progressive enlargement of the esophagus (megaesophagus)
• Chronic inflammation and ulceration of the esophagus
• Recurrent aspiration pneumonia
• Increased risk of esophageal cancer over many years

Early diagnosis and appropriate treatment significantly reduce these risks.

How is achalasia cardia diagnosed?

Diagnosis needs a combination of history, physical examination, and specialized tests.

What is a barium swallow test, and how does it help?

In a barium swallow study:-

• The patient drinks a contrast liquid.
• X-ray images track its movement through the esophagus.

Typical findings include:

• Dilated esophagus
• Narrowing at the lower end
• Delayed emptying into the stomach
• “Bird-beak” appearance at the LES

Why is esophageal manometry necessary?

Esophageal manometry is the definitive diagnostic examination for achalasia that contemplates:-

• Strength of esophageal muscle contractions
• Coordination of swallowing
• LES pressure and relaxation

Manometry also helps classify achalasia into subtypes, which is critical for treatment planning.

What role does upper GI endoscopy play?

Upper GI endoscopy allows doctors to:-

• Rule out cancers or strictures.
• Assess the esophageal lining.
• Remove retained food if present.
• Evaluate inflammation or ulceration.

It is an essential part of the evaluation of achalasia.

Are there different types of achalasia?

Yes. Doctors divide achalasia into three types depending on manometry:-

• Type I (Classic achalasia): Minimal esophageal contraction
• Type II: Esophageal pressurization during swallowing
• Type III (Spastic achalasia): Abnormal, forceful contractions

Type II generally responds best to treatment, while Type III requires more specialized approaches.

How is achalasia cardia treated?

There is no permanent cure, but treatment focuses on relieving obstruction at the LES and improving esophageal emptying.

What medical (non-surgical) treatments are available?

Medications

The LES may become momentarily relaxed by medications such as calcium channel blockers and nitrates, but they:-

• Provide limited relief
• They are usually not effective long-term.

What is botulinum toxin (Botox) injection?

Botox injection:-

• Is given endoscopically into the LES
• Temporarily weakens the muscle.
• Provides symptom relief for 6–12 months

It is mainly helpful for elderly patients or those unfit for surgery.

What is pneumatic balloon dilation?

This procedure uses a balloon to stretch the LES. While effective in some cases, it:-

• May need repeat sessions
• Carries a small risk of esophageal perforation

What is laparoscopic Heller myotomy?

Laparoscopic Heller myotomy is considered the gold standard surgical treatment for achalasia cardia.

What does the surgery involve?

• Minimally invasive laparoscopic technique
• Precise cutting of the LES muscle fibers
• Usually combined with partial fundoplication to prevent acid reflux.

What are the advantages?

• Durable symptom relief
• Short hospital stay
• Faster recovery
• Excellent long-term outcomes

What is POEM (Peroral Endoscopic Myotomy)?

POEM is an advanced endoscopic procedure performed through the mouth. It:-

• Cuts the LES muscle internally
• Leaves no external scars
• It is beneficial for Type III achalasia.

Long-term reflux monitoring is essential after POEM.

How is the best treatment option decided?

Treatment choice depends on:-

• Age and general health
• Type of achalasia
• Severity of symptoms
• Available surgical expertise

A multidisciplinary approach ensures optimal care.

What can we expect after treatment?

The following are the effects you can experience:-

• Marked improvement in swallowing
• Better nutrition and weight gain
• Improved sleep and quality of life

Follow-up is essential to manage reflux or recurrence.

What dietary changes are advisable after treatment?

Initially - Liquids and soft foods

Gradually - Normal diet as tolerated

Patients get advice to:-

• Eat slowly
• Chew thoroughly
• Avoid late-night meals
• Stay upright after eating.

Can achalasia recur after treatment?

Recurrence is uncommon but possible due to:-

• Scar formation
• Incomplete myotomy
• Disease progression

Early evaluation ensures effective management.

When should a patient consult a surgeon?

Doctors recommend surgical consultation when:-

• Swallowing difficulty worsens
• Weight loss occurs
• Non-surgical treatments fail
• Recurrent chest infections develop.

Why choose Tender Palm Super-Speciality Hospital for Achalasia Cardia treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Achalasia Cardia treatment in Lucknow, India, at an affordable cost. We have a team of experienced surgeons and gastrointestinal specialists who provide accurate diagnosis with advanced imaging, personalized medical care, and minimally invasive surgical options. Our General and Laparoscopic Surgery team has decades of experience in successfully treating Achalasia Cardia in Lucknow, India.

To seek an Expert Consultation for Achalasia Cardia treatment in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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