Achalasia cardia Home A-Z Health Information Health Library A-Z Achalasia Cardia Overview Achalasia cardia is a serious disorder affecting the food pipe (oesophagus). It is a rare condition, wherein the lower oesophageal sphincter (LES) is unable to relax properly, a phenomenon that hinders the efficient passage of food and liquids into the stomach. Furthermore, peristalsis (the coordinated contractions of the oesophagus) is also affected, which further impairs the movement of food. This leads to dysphagia (difficulty swallowing), regurgitation, and other symptoms related to poor oesophageal motility. Causes and risk factors Neurological dysfunction: The primary cause of achalasia cardia is the degeneration of specialised nerve cells (ganglion cells) that are responsible for controlling the muscles of the oesophagus and the LES. Without proper nerve function, the LES fails to relax, and the oesophagus loses its ability to move food downward via peristalsis.Genetic factorsAutoimmune responsesViral infections: Certain viral infections, particularly Chagas disease (caused by Trypanosoma cruzi), can lead to achalasia by damaging the nerves in the oesophagus.Other diseases: Achalasia can also occur secondary to other diseases, such as Chagas disease or cancer of the oesophagus, although this is much less common. Symptoms Difficulty in swallowing): even swallowing liquids may become difficult as the disease progresses.Regurgitation of food or liquids, especially when reclining. This might result in coughing or choking, and can sometimes even culminate in aspiration (food or liquid entering the lungs).Aspiration pneumoniaHeartburnChest painWeight loss Diagnosis Barium swallow (Esophagram): This imaging modality involves swallowing a contrast medium (barium) by the patient to visualise the oesophagus. In the barium swallow test, achalasia typically presents a "bird's beak" appearance at the lower oesophageal sphincter (LES), where the oesophagus narrows down owing to the inability of the LES to relax.Oesophageal manometry: This test is the gold standard for diagnosing achalasia; it involves measuring the pressure inside the oesophagus and evaluating the function of the LES. In achalasia, the manometry will reveal a lack of oesophageal peristalsis and incomplete LES relaxation during swallowing.Endoscopy (oesophagogastroduodenoscopy or EGD)Oesophageal pH monitoring: This test involves evaluating the amount of acid reflux into the oesophagus. It is useful to rule out gastroesophageal reflux disease (GERD) or other reflux-related conditions.CT or MRI Treatment Medications:Nitrates or calcium channel blockers: These medications may help relax the lower oesophageal stricture (LES) and improve swallowing. However, their effectiveness is usually limited, and they are often only helpful in mild cases or as a short-term solution(s).Botulinum toxin (Botox): Injections of Botox into the LES can temporarily paralyse the muscle, allowing it to relax and improve swallowing. This treatment is often used in older patients or individuals who are not candidates for surgery, but the effects typically wear off after a few months.Pneumatic dilation: This involves using a balloon to stretch and widen the LES. The procedure is performed under sedation and can offer significant symptom relief in many patients. It is effective for many, but the procedure may need to be repeated, and there is a risk of oesophageal perforation.Surgical treatment:Heller myotomy: This surgical modality involves cutting the muscle of the LES to allow easier passage of food into the stomach. Heller myotomy is a very effective treatment for achalasia and is typically performed laparoscopically (minimally invasive surgery that involves making tiny incisions).Peroral endoscopic myotomy (POEM): This endoscopic procedure (less invasive than Heller myotomy) involves the use of an endoscope to cut the muscle of the LES. POEM is more effective and less invasive than Heller myotomy.Oesophageal stenting: In rare cases, a stent may be placed in the oesophagus to keep it open. This is typically used when other treatments are not effective or if there is a significant narrowing.Lifestyle and dietary changes:Eating smaller portions and consuming soft, easy-to-swallow foods may help manage symptoms.Avoiding lying down immediately after eating and eating slowly may also alleviate regurgitation and discomfort. When to see a doctor Consult a medical professional if you experience dysphagia (difficulty swallowing), chest pain, regurgitation, or unintentional weight loss.