Achalasia Cardia: Symptoms, Causes, Diagnosis, and Treatment
Introduction
Achalasia cardia is a rare but serious disorder of the esophagus (food pipe) that makes it difficult for food and liquids to pass into the stomach. It occurs due to a problem with the muscles and nerves of the esophagus, leading to difficulty in swallowing and regurgitation of food. Early diagnosis and proper treatment can significantly improve quality of life.
What Is Achalasia Cardia?
Achalasia cardia is a motility disorder of the esophagus in which:
The lower esophageal sphincter (LES) fails to relax properly
Normal esophageal muscle movements (peristalsis) are absent
As a result, food gets stuck in the esophagus instead of moving smoothly into the stomach.
Causes of Achalasia Cardia
The exact cause of achalasia cardia is not always known, but it is believed to occur due to daage to the nervesm controlling the esophagus.
Possible causes include:
Degeneration of esophageal nerve cells
Autoimmune reactions
Viral infections
Rare genetic factors
In some cases, achalasia may be associated with conditions like Chagas disease (more common in certain regions).
Symptoms of Achalasia Cardia
Symptoms usually develop gradually and worsen over time.
Common symptoms include:
Difficulty swallowing (dysphagia) for solids and liquids
Regurgitation of undigested food
Chest pain or discomfort
Heartburn-like symptoms
Chronic cough, especially at night
Weight loss
Aspiration or recurrent respiratory infections
How Is Achalasia Cardia Diagnosed?
Doctors use a combination of tests to confirm the diagnosis:
1. Barium Swallow X-ray
Shows a narrowed lower esophagus with a classic “bird-beak” appearance.
2. Esophageal Manometry
The gold standard test that measures esophageal muscle contractions and LES pressure.
3. Upper GI Endoscopy
Helps rule out other conditions like esophageal cancer or strictures.
Treatment Options for Achalasia Cardia
There is no permanent cure, but treatments aim to relax the lower esophageal sphincter and improve swallowing.
1. Medications
Nitrates
Calcium channel blockers
(Usually provide temporary relief and are less effective)
2. Pneumatic Balloon Dilatation
A balloon is used to stretch the LES. Effective in many patients but may require repeat sessions.
3. Botox Injection
Botulinum toxin is injected into the LES to relax it. Best for elderly or high-risk patients.
4. Surgical Treatment – Heller Myotomy
A minimally invasive surgery where the LES muscle is cut to allow easier passage of food. Often combined with anti-reflux surgery.
5. POEM (Peroral Endoscopic Myotomy)
A newer, advanced endoscopic procedure with excellent results and faster recovery.
Diet and Lifestyle Tips
Eat slowly and chew food thoroughly
Drink water while eating
Avoid eating before bedtime
Sleep with head elevated
Prefer soft or semi-solid foods if symptoms are severe
Possible Complications
If left untreated, achalasia cardia can lead to:
Severe weight loss
Aspiration pneumonia
Esophageal dilation
Increased risk of esophageal cancer (rare but important)
When to See a Doctor
Consult a gastroenterologist if you experience:
Persistent difficulty swallowing
Regurgitation of food
Unexplained weight loss
Chest pain not related to the heart
Early diagnosis leads to better outcomes.
Conclusion
Achalasia cardia is a chronic esophageal condition that can significantly affect daily life if untreated. With modern diagnostic tools and advanced treatments like POEM and laparoscopic surgery, most patients can achieve long-term symptom relief. If you or a loved one has ongoing swallowing problems, timely medical evaluation is essential.