Achalasia Cardia: Symptoms, Diagnosis, and Treatment Guide
Learn about Achalasia Cardia, including its symptoms, diagnosis methods, and treatment options to manage this rare oesophageal disorder effectively.
Written by Dr. Rohinipriyanka Pondugula
Reviewed by Dr. Md Yusuf Shareef MBBS
Last updated on 8th Sep, 2025
Introduction
Have you ever felt like food just won't go down properly? While occasional heartburn is common, persistent difficulty swallowing can be a sign of a more serious condition. Achalasia cardia is a rare but impactful disorder of the oesophagus, the tube that carries food from your mouth to your stomach. It occurs when the nerve cells in the oesophagus degenerate, preventing it from squeezing food down and stopping the valve at the bottom (the lower oesophageal sphincter) from relaxing. This results in a frustrating and often painful backlog of food and liquid. This comprehensive guide will walk you through everything you need to know about achalasia, from recognizing its subtle early symptoms to understanding the latest diagnostic tests and effective treatment options to reclaim your ability to eat comfortably.
What is Achalasia Cardia? Understanding the Basics
Achalasia cardia is a primary oesophageal motility disorder. In simple terms, "motility" refers to the movement of muscles, and "disorder" means this movement is impaired. It's not that there's a physical blockage like a tumour; rather, the muscles and nerves that coordinate swallowing simply don't work as they should. The condition is characterized by two main problems: first, the oesophagus loses its ability to push food downward through peristalsis (wave-like muscle contractions). Second, the lower oesophageal sphincter (LOS), a ring of muscle that acts as a valve between the oesophagus and stomach, fails to relax and open fully when you swallow. This combination creates a functional obstruction, making it incredibly difficult for food and liquid to enter the stomach.
The Role of Your Ooesophagus and LOS
Your oesophagus is a muscular highway for food. When you swallow, coordinated waves of contraction (peristalsis) propel the food bolus downward. As it approaches the stomach, the LOS, which is normally tightly closed to prevent stomach acid from splashing back, should momentarily relax and open to let the food pass through. It's a beautifully synchronized process that we take for granted until it malfunctions.
What Goes Wrong in Achalasia?
In people with achalasia, the nerve cells within the oesophagus (specifically, the Auerbach's plexus) are damaged or destroyed. The cause of this damage is not fully understood but is thought to be autoimmune. Without these nerves to transmit signals, the muscle of the oesophagus cannot contract properly, and the LOS cannot receive the "open" command. It remains tightly closed, turning a simple meal into an uphill battle.
Consult a Gastroenterologist for the best advice
Recognizing the Signs: Common Symptoms of Achalasia
The symptoms of achalasia often develop gradually over months or even years, which can lead to a delayed diagnosis. The most common symptom, present in nearly all patients, is dysphagia, or difficulty swallowing. Patients often report a sensation that food or liquid is stuck in their chest or throat. Interestingly, unlike a stricture, swallowing solids might be problematic initially, but as the oesophagus dilates, swallowing liquids can become equally or more difficult.
Early Warning Signs You Might Miss
Before full-blown difficulty swallowing food becomes apparent, people might experience:
Regurgitation: The effortless return of undigested food or saliva, often without sour-tasting stomach acid. This can happen hours after eating and can be mistaken for vomiting.
Chest Pain: Discomfort or pain behind the breastbone, which can be severe and sometimes mistaken for a heart attack.
Heartburn: A burning sensation caused by the fermentation of old food in the oesophagus, not true acid reflux. This means it often doesn't respond well to standard antacids.
When Symptoms Escalate: Complications to Watch For
If left untreated, persistent achalasia can lead to more serious issues:
Significant Weight Loss: Due to the fear of eating and caloric deficiency.
Nocturnal Coughing: Choking or coughing at night due to regurgitated material entering the lungs.
Aspiration Pneumonia: A lung infection caused by inhaling food or liquid.
Megaooesophagus: A severe dilation and stretching of the oesophagus, which significantly increases cancer risk and makes treatment more challenging.
Getting a Diagnosis: How Doctors Identify Achalasia
Because its symptoms mimic other conditions like GORD, diagnosing achalasia requires specific tests. If your achalasia chest pain and dysphagia persist, a doctor will typically recommend a series of investigations.
The Gold Standard: High-Resolution Ooesophageal Manometry (HRM)
This is the most important test for confirming achalasia. A thin, flexible catheter is passed through the nose into the oesophagus. It contains multiple sensors that measure pressure contractions throughout the oesophagus and the LOS when you swallow small sips of water. HRM provides a detailed pressure map that clearly shows the lack of peristalsis and the failure of the LOS to relax, which is the hallmark of achalasia.
Supporting Tests: Endoscopy and Barium Swallow
Endoscopy: A camera on a flexible tube is used to visually examine the lining of the oesophagus, stomach, and duodenum. While it may appear normal in early achalasia, it rules out cancer as a cause of the obstruction. In advanced cases, a dilated oesophagus with retained food and saliva is visible.
Barium Swallow: You drink a chalky liquid (barium) that coats the oesophagus, making it visible on X-ray. The classic sign of achalasia is a "bird's beak" appearance, where the barium column tapers sharply at the tight LOS, with a dilated oesophagus above it.
Classifying the Type: The Chicago Classification
HRM allows doctors to classify achalasia into three subtypes based on the pressure patterns, which can help guide treatment decisions. Type II, for instance, often responds best to any therapy, while Type III (spastic) might be better suited to a longer myotomy, often achieved with the POEM surgery procedure.
Exploring Your Treatment Options for Achalasia
There is no cure for achalasia, and the nerve damage cannot be reversed. Therefore, the goal of all treatments is to weaken or cut the tight lower oesophageal sphincter muscle to allow food to pass through more easily by gravity. The choice of treatment depends on your age, health, the subtype of achalasia, and local expertise.
Goal of Treatment: Relieving the Obstruction
All effective therapies focus on disrupting the muscle fibers of the LOS. The challenge is to do it just enough to relieve the obstruction without causing debilitating gastro-oesophageal reflux disease (GORD) afterward.
Minimally Invasive Procedure: Peroral Endoscopic Myotomy (POEM)
A highly effective and increasingly popular procedure, POEM is performed entirely through an endoscope passed through the mouth. The doctor creates a tunnel within the lining of the oesophagus and then cuts the muscle (myotomy) from the inside. It is excellent for all types of achalasia, especially Type III, and has a very high success rate with a quick recovery time.
Surgical Approach: Laparoscopic Heller Myotomy
This is the traditional surgical gold standard. The surgeon makes small incisions in the abdomen and uses a camera and instruments to access and cut the outer muscle layer of the LOS. It is almost always combined with a partial fundoplication, a procedure to wrap part of the stomach around the oesophagus to prevent reflux post-surgery.
Non-Surgical Option: Pneumatic Dilation
This older procedure involves passing a balloon through the LOS under endoscopic guidance and inflating it to forcibly tear the muscle fibers. It is less invasive than surgery but may need to be repeated and carries a small risk of oesophageal perforation. Its effectiveness can vary.
Managing Symptoms: Medications and Botox Injections
Botox Injections: Botulinum toxin (Botox) can be injected directly into the LOS during endoscopy. It paralyzes the tight muscle, providing temporary relief (usually 6-12 months). It's best for patients who are poor candidates for more definitive procedures or as a temporary bridge.
Medications: Nitrates or calcium channel blockers can help relax the LOS. Their effect is short-lived and side effects are common, so they are rarely used long-term.
If you are experiencing persistent swallowing difficulties, it is crucial to consult a specialist for an accurate diagnosis. You can consult a gastroenterologist online with Apollo24|7 to discuss your symptoms and determine the right diagnostic path for you.
Life After Treatment: Diet, Lifestyle, and Long-Term Outlook
Treatment is not a one-time fix; it's the beginning of a new management phase. Most people experience dramatic improvement, but they rarely regain a completely normal swallowing mechanism.
The Achalasia Diet: Foods to Eat and Avoid
There is no one-size-fits-all diet, but general tips can help:
Focus on: Soft, moist, and pureed foods. Soups, smoothies, yogurt, mashed potatoes, and well-cooked grains are often easier to manage.
Avoid: Tough, dry meats, dry bread, sticky rice, and raw vegetables. Carbonated drinks can sometimes help push food down but can also cause bloating.
Always: Eat slowly, chew thoroughly, and drink plenty of fluids with meals.
Tips for Easier Eating and Drinking
Eat smaller, more frequent meals.
Stay upright during meals and for at least 2-3 hours afterward.
Sleep with the head of your bed elevated to help clear any residual food from the oesophagus overnight.
Even after successful treatment, annual follow-ups with a gastroenterologist are recommended to monitor for potential complications like reflux or, in very rare cases, oesophageal cancer.
Conclusion
Living with achalasia cardia can be a challenging journey, marked by frustration and uncertainty. However, it's crucial to remember that this condition is manageable. Modern medicine offers highly effective diagnostic tools and treatment options that can dramatically improve your quality of life. From the precision of high-resolution manometry to the minimally invasive innovation of procedures like POEM, the goal is to help you return to enjoying meals without fear or discomfort. While it requires ongoing attention and lifestyle adaptations, a diagnosis of achalasia is not the end of normalcy; it's the start of a new, well-informed chapter in your health.
Consult a Gastroenterologist for the best advice
Consult a Gastroenterologist for the best advice
Dr. Santhosh Kumar
Gastroenterology/gi Medicine Specialist
7 Years • MBBS, MD (General Medicine), DNB ( Gastroenterology)
Bengaluru
VISTA SPECIALITY CLINIC, Bengaluru
Dr Rohit Sureka
Gastroenterology/gi Medicine Specialist
15 Years • MBBS, DNB General Medicine, DNB Gastroenterology
Jaipur
Apollo 247 virtual - Rajasthan, Jaipur
Dr. Jatin Yegurla
Gastroenterology/gi Medicine Specialist
11 Years • MD (PGI), DM (AIIMS Delhi), FAGIE (AIIMS Delhi), ESEGH (UK), Gold Medalist
Hyderabad
Apollo Hospitals Jubilee Hills, Hyderabad
(625+ Patients)
Dr Harish K C
Gastroenterology/gi Medicine Specialist
15 Years • MBBS MD DM MRCP(UK) (SCE-Gastroenterology and Hepatology)
Bengaluru
Apollo Clinic, JP nagar, Bengaluru
Dr. Chethan T L
General Physician/ Internal Medicine Specialist
5 Years • MBBS, MD, DNB (General Medicine)
Bengaluru
Apollo Medical Center, Marathahalli, Bengaluru
Frequently Asked Questions
1. Can achalasia be cured?
No, achalasia cannot be cured because the nerve damage is permanent. However, the symptoms can be very effectively managed long-term with procedures that cut or stretch the tight muscle valve (LOS), allowing food to pass through easily.
2. What is the difference between achalasia and GORD?
They are often confused because both can cause heartburn and regurgitation. The key difference is the cause: GORD is caused by a weak LOS that opens too much, allowing acid to reflux. Achalasia is caused by a tight LOS that won't open enough to let food down. The regurgitated material in achalasia is usually undigested food, not sour-tasting acid.
3. Is achalasia a hereditary condition?
In the vast majority of cases, achalasia is not hereditary and occurs sporadically. However, there are very rare familial clusters and associations with certain genetic syndromes, suggesting a possible genetic predisposition in a small subset of patients.
4. What is the success rate of POEM surgery?
The POEM surgery success rate is very high, with clinical success (significant improvement in symptoms) achieved in over 90-95% of patients in the short term. Long-term studies show sustained efficacy in over 80-90% of patients after 3-5 years.
5. Does having achalasia increase my risk of oesophageal cancer?
Yes, having achalasia does slightly increase the long-term risk of developing oesophageal cancer, specifically squamous cell carcinoma. This risk is believed to be due to chronic irritation from food stagnating in the oesophagus. This is why ongoing monitoring with a gastroenterologist is important, even after successful treatment.