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Achalasia Cardia: Symptoms, Causes, Diagnosis, & Treatment

By Dr. Vikas Singla in Gastroenterology, Hepatology & Endoscopy

Apr 27 , 2021 | 2 min read

Achalasia cardia, often referred to as achalasia, affects the esophagus (the tube that carries swallowed food from the throat down into the stomach).

A ring of muscle called the lower esophageal sphincter encircles the lower esophagus just above the stomach. This sphincter muscle when contracts, closes the esophagus. When the sphincter is closed, the contents of the stomach cannot flow back into the esophagus. Backward flow of stomach contents (reflux) can irritate and inflame the esophagus, causing symptoms such as heartburn. The act of swallowing causes a wave of esophageal contraction called peristalsis, which pushes the food along the esophagus down into the stomach. Normally, during peristalsis, esophageal sphincter relaxes to allow the food into the stomach. In achalasia, which means ❝failure to relax❞, is a rare esophageal motility disorder in which the normal esophageal peristalsis and the lower esophageal sphincter relaxation are impaired. 

Symptoms 

Achalasia patients complain of difficulty in swallowing, sensation of food or water getting stuck in the chest, chest pain (which can be sometimes mistaken for heart attack), regurgitation of food and weight loss.

Diagnosis 

Diagnosis of achalasia begins with a careful medical history focusing on the timing of symptoms and eliminating other medical conditions that may cause similar symptoms. 

Endoscopy, which is used to look directly into the esophagus can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can mimic achalasia. 

Esophageal manometry is the test which can confirm the diagnosis of achalasia. In Manometry, a thin probe is passed through the esophagus to assess the peristalsis and lower esophageal sphincter relaxation during swallowing.
Barium swallow is another useful investigation, during which patient swallows a solution containing barium. An X ray is performed, which confirms non relaxation of achalasia cardia.

Treatment 

Medical therapy has limited efficacy in the treatment for achalasia cardia. Endoscopic botulinum injection, balloon dilatation(Penumatic), and Lap Heller Myotomy (Surgery) has been the conventional treatment for Achalasia Cardia. In the recent time, POEM (per oral endoscopic myotomy) has emerged as new and effective treatment for achalasia cardia.

We at Max Super Speciality hospital are one of the few centers where manometry is being performed and we offer incisionless endoscopic surgery called POEM (Per oral endoscopic myotomy) for achalasia. POEM procedure for achalasia is a safe procedure offering excellent long-term results, also not requiring long hospital stay. After 24 hours of POEM procedure liquid diet is started.

At Max hospital Saket, our gastroenterology team with cumulative experience of more than 150,000 endoscopic procedures, is providing the cutting edge treatment for patients with coplex GI disorders. Our team, under the leadership of Dr Vikas Singla, has one of the highest experience for treatment of achalasia cardia. Team has already performed more than 400 cases of per oral endoscopy myotomy in patients of achalasia cardia with the excellent results.