Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Discover everything about Achalasia Cardia — its symptoms, causes, diagnosis, treatment options, and lifestyle tips. Learn how to manage this rare esophageal disorder effectively.
Achalasia cardia also called esophageal achalasia or cardio spasm is a rare but serious condition. It occurs (incidence) in 1 in 1,00,000 people per year. Its prevalence is 10 in 1,00,000 people. Most common age group is 40 to 60 yrs. It occurs equally in both sexes.
Although achalasia is uncommon, it can significantly impact quality of life if left untreated. Understanding its symptoms, causes, and available treatments is vital for early diagnosis and effective management.
When we eat or drink, the food or liquid goes to the stomach from the mouth through a tube that is called esophagus. Esophagus squeezes the food or liquid and sends it down into the stomach.
At the junction of esophagus and stomach there is a ring of muscle called lower esophageal sphincter (LES), that opens transiently when food or liquid enters the stomach from the esophagus.
Two factors play a role in causing achalasia cardia.
1 The nerves in the esophagus become damaged, the esophagus becomes paralyzed and cannot squeeze the food and drink to send it into the stomach.
2 There is constant spasm of the lower esophageal sphincter, and the sphincter cannot open properly.
As a result, food accumulates in the esophagus, esophagus may dilate. Sometimes there is huge dilatation of the esophagus. The accumulated food may undergo fermentation and come back into the mouth. People with achalasia cardia may think that they are suffering from gastroesophageal reflux disease (GERD).
In GERD food comes from the stomach but in achalasia cardia food comes from the esophagus.[Read more about GERD.]
There are three main types of achalasia:
- Type I (Classic Achalasia): Minimal esophageal pressure and poor movement.
- Type II (Achalasia with Compression): Increased esophageal pressure during swallowing.
- Type III (Spastic Achalasia): Irregular and uncoordinated contractions.
Each type has slightly different symptoms and may respond differently to treatment.
Symptoms of Achalasia Cardia
The symptoms of achalasia develop gradually but worsen over time. Recognizing them early helps in timely medical intervention. Common symptoms include:
- Difficulty Swallowing (Dysphagia): This is the hallmark symptom. Patients often feel like food is getting stuck in their chest or throat.
- Regurgitation of Undigested Food: Food may come back up, especially when lying down.
- Chest Pain or Discomfort: Some experience tightness or burning sensations that can mimic heart pain.
- Heartburn and Acid Reflux: These occur due to food backing up into the esophagus.
- Weight Loss: Difficulty eating leads to unintentional weight loss.
- Coughing or Aspiration: Particularly at night, food or liquid may enter the airway, causing coughing fits.
Since symptoms resemble those of gastroesophageal reflux disease (GERD), achalasia is often misdiagnosed. Persistent swallowing difficulties should never be ignored.
When to See a Doctor
Seek medical attention immediately if you experience:
- Difficulty swallowing both solid and liquid foods.
- Frequent regurgitation of undigested food.
- Chest pain unrelated to heart problems.
- Unexplained weight loss.
Early evaluation by a gastroenterologist can prevent complications such as esophageal dilation or inflammation. Delaying diagnosis can make the condition more challenging to treat.
Causes of Achalasia Cardia
While the exact cause remains unclear, several theories exist regarding the development of achalasia. Researchers suspect autoimmune, genetic, and infectious factors may play roles.
1. Nerve Degeneration
The most accepted theory suggests the gradual loss of inhibitory nerve cells in the esophagus, disrupting the muscle relaxation process.
2. Autoimmune Reaction
In some individuals, the immune system mistakenly attacks nerve cells in the esophagus, impairing their function.
3. Viral or Infectious Causes
Certain viral infections such as herpes simplex or measles virus have been linked to nerve damage that could lead to achalasia.
4. Genetic Factors
Although rare, familial cases have been reported, indicating a potential hereditary component.
Risk Factors of Achalasia Cardia
Achalasia can occur in anyone, but certain factors increase the risk:
- Age: Most cases occur between ages 40–60.
- Genetics: A family history of achalasia may slightly raise the risk.
- Autoimmune Disorders: People with autoimmune diseases like lupus or Sjögren’s syndrome may be more prone.
- Chagas Disease: Caused by a parasitic infection in Latin America, it mimics achalasia symptoms.
Understanding these risk factors helps identify individuals who should undergo early screening.
Complications of Achalasia Cardia
If untreated, achalasia can lead to severe complications:
- Esophageal Dilation: Chronic food buildup stretches the esophagus.
- Esophagitis: Inflammation caused by food retention and acid reflux.
- Aspiration Pneumonia: Regurgitated food entering the lungs causes infection.
- Malnutrition: Reduced food intake leads to nutrient deficiencies.
- Esophageal Cancer: Long-term achalasia increases the risk of esophageal squamous cell carcinoma.
Proper diagnosis and timely treatment can significantly lower these risks.
Prevention of Achalasia Cardia
Since the underlying cause isn’t fully understood, there’s no guaranteed way to prevent achalasia. However, you can minimize risks by:
- Maintaining good digestive health.
- Avoiding exposure to infectious agents linked with nerve damage.
- Seeking early medical help for persistent swallowing issues.
- Managing autoimmune conditions effectively.
Routine check-ups and awareness of early symptoms are your best defense.
Diagnosis of Achalasia Cardia
Diagnosing Achalasia Cardia can be challenging because its symptoms often mimic other digestive disorders like GERD (Gastroesophageal Reflux Disease) or esophageal strictures. However, several advanced diagnostic tests help confirm the condition accurately. Early diagnosis plays a crucial role in preventing long-term complications.
1. Barium Swallow (Esophagram)
This is usually the first test recommended. You’ll be asked to swallow a chalky liquid containing barium, which coats the esophagus and shows up on X-rays.
What it shows: A narrowed lower esophageal sphincter and a dilated esophagus above it — often described as a “bird’s beak” appearance, a classic sign of achalasia.
2. Esophageal Manometry
This is considered the gold standard for diagnosing achalasia. A thin tube is inserted through your nose into the esophagus to measure muscle contractions and sphincter pressure during swallowing.
What it detects: Absence of normal peristalsis and failure of the LES to relax.
3. Endoscopy (EGD)
A flexible tube with a camera is inserted through the mouth to visualize the esophagus and stomach.
Purpose: Helps rule out other causes of obstruction, such as tumors or strictures, that can mimic achalasia (a condition called pseudoachalasia).
4. CT Scan or MRI
Sometimes used when doctors suspect cancer or other structural abnormalities. These imaging techniques provide a detailed look at surrounding tissues and the esophageal wall.
A combination of these tests gives doctors the most accurate diagnosis, guiding the right treatment strategy for each patient.
Treatment of achalasia cardia
