What is achalasia cardia?
The cardia is the junction where the esophagus meets the stomach. In achalasia, the muscle ring at this junction does not relax properly during swallowing, and the esophagus loses its normal coordinated squeezing motion, so food and liquid pass slowly, or not at all, into the stomach.
Symptoms & when to see a doctor
Common symptoms include difficulty swallowing solids and liquids, regurgitation of undigested food, chest discomfort and unintentional weight loss. Diagnosis is usually confirmed with endoscopy, a barium swallow study and esophageal manometry (a test that measures the pressure and movement of the esophagus).
Treatment options
Treatment aims to relax or open the tight muscle so that food and liquid can pass more easily into the stomach. There is no cure for the underlying nerve changes that cause achalasia, but symptoms can usually be well managed.
- Laparoscopic Heller myotomy: surgically cutting the tight muscle fibres, usually combined with a fundoplication to reduce the risk of reflux afterwards
- Pneumatic balloon dilatation: endoscopic stretching of the tight muscle
- Peroral endoscopic myotomy (POEM): an endoscopic technique used in selected cases
Recovery
Recovery after laparoscopic Heller myotomy is generally quicker than after open surgery, with most people resuming a normal diet gradually as advised by their care team.
Where suitable, this may be carried out using minimally invasive techniques. See Minimally Invasive Surgery.
Frequently asked questions
What is a Heller myotomy?
It is an operation that cuts the tight muscle fibres at the lower end of the esophagus to allow food and liquid to pass more easily into the stomach. It is usually performed laparoscopically and combined with a fundoplication.
Is achalasia curable?
There is no cure for the underlying nerve changes that cause achalasia, but treatments such as Heller myotomy, balloon dilatation and POEM can effectively relieve symptoms for most people.
Do I need surgery, or can achalasia be treated without it?
Several options exist, including endoscopic balloon dilatation and POEM as well as surgery. The most suitable option depends on individual factors, which your specialist will discuss with you.