What is achalasia cardia, its symptoms, complications, investigations and treatment

What is achalasia cardia, its symptoms, complications, investigations and treatment

It is also known as cardiospasm for Mega-esophagus. The lower part of our esophagus which opens into the stomach is protected by a muscular ring also called as Lower Esophageal Sphincter (LES) to protect stomach acid to reflux into the esophagus.

Improper function or failure of relaxation of this LES on swallowing food is the main characteristic of achalasia cardia. So it is primarily a motor disorder where degeneration of neuron cell body of the esophagus is thought to be the primary cause.



It is a prominent symptom. The affected person feels obstruction of foods at the lower part of the esophagus and sometimes high in the esophagus also. It is intermittent at first but when the disease progresses it becomes continuous and at every meal, especially with solid foods.


Regurgitation of ingested food is another symptom. This is immediate in the initial stage but later on, the esophagus gets dilated and ingested food retained in it for hours and days also causing delayed regurgitation.

Chest pain and heartburn:

Chest pain can occur day and night below the sternum. It may be severe and maybe relieved by cold water drinking.

If an affected person drinks fast, there may be a bursting feeling or sensation of food sticking.

Burning in the esophagus or heartburn when patient lye down or during stooping

Cough and dyspnea:

The dilated esophagus may cause pressure on the trachea and bronchi which causes dyspnea and coughing.

Other respiratory problems like pneumonia, bronchiectasis, or lung abscess can occur due to aspiration of regurgitated food or gastric content.


Many times patients may not have any symptoms but the condition may get revealed during routine investigations such as X-ray of the chest.



Due to recurrent aspiration and infection into the lungs, persons may develop pneumonia, lung abscess, or fibrosis.


It is one of the rare complications of achalasia.


It may happen and is common in the mid-esophagus area due to chronic stasis esophagitis which irritates the area recurrently.



  • X-ray of chest: It will help to diagnose mediastinal shadow enlargement and dilatation of the esophagus.
  • Barium swallow: It will show ‘bird beak sign‘ in which there is dilatation of the esophagus and slow flow into the stomach via a smoothly narrowed gastroesophageal junction. There is also an absence of bubble gas in the stomach.


It is the most helpful diagnostic test and also have the ability to take a biopsy whenever required.


It detects the strength and coordination of the muscles of the esophagus and the lower esophageal sphincter.



Isosorbide dinitrate or nifedipine has a relaxant effect on LES muscle.

Pneumatic dilatation and Extramucosal Esophagomyotomy:

In this procedure, stretching is done by positioning an inflatable balloon within the esophageal lumen.

Another surgical procedure is known as Heller’s operation, in this surgical procedure myotomy at the cardia is performed. The most common complication of both the procedure is gastroesophageal reflux.

Botulinum toxin:

It is alternative management of surgery or pneumatic dilatation in which endoscopic intrasphincteric injection of botulinum toxin is given. It is useful in elder or delicate patients. The injection is given multiple times over a period of time but on successive injections, effects may last for a longer time.

This article is for education purposes only. Take the advice of your doctor before taking any action. Thank you.

Achalasia cardia FAQs

How to investigate or diagnose achalasia cardia?

In the above section of Investigation, I have explained the investigations required for the diagnosis of the disorder.
Barium swallow radiography especially Timed Barium Esophagography (TBE) is very useful. In this 200 to 250 ml of low-density barium that is 45% is swallowed and multiple x-rays is taken at a fixed interval like 1, 2, and 5 minutes. It is helpful to find out about relapses of the disease and to estimate how the treatment affected the disease.
Another investigation method is manometry. Now High-Resolution Manometry (HRM)is more widely used than the old method. It will find out the motility and strength disorder of the esophagus.
Endoscopy as I explained also helpful to find out esophagitis and other disorders. Another advanced technique called Endoluminal Functional Lumen Imaging Probe (EndoFLIP) can be successfully used to diagnose achalasia.

Is achalasia cardia hereditary?

It is primarily motor neuron disorder in which the degeneration of neuronal cells of the esophagus occurs resulting in the disease. The exact cause is still unclear. Some recent studies show that some viruses like the herpes virus may trigger the immunological process, especially in genetically predisposed persons. No other solid evidence is there that suggests its hereditary connection.

What is achalasia cardia ICD 10?

ICD is the International Classification of Diseases and ICD 10 means the 10th revision of the ICD. Various diseases are classified and coded in this method.
K00 to K95 is the code for Diseases of the digestive system. And in this K20 to K31 is the codes for Diseases of the esophagus, stomach, and duodenum.
K-22 code refers to Other diseases of the esophagus and K-22.0 is the code for the achalasia of cardia in ICD-10.

Is achalasia cardia contagious?

Contagious or infectious diseases spread through person to person in different ways. In achalasia, there is no involvement of any infectious agent. So it is not a contagious or infectious disease. However recent study shows that some virus-like herpes causes an immunological reaction in the affected person causing it. But there is no direct infection of any other infectious agents.

Is achalasia cardia is cancer?

No, it is not cancer. But as a complication of achalasia carcinoma can develop in affected patients. Please refer complication section above for more details of it.

Is achalasia cardia curable?

When there is complete degeneration of motor neuron cells affecting the esophagus, it is very very difficult to cure. Different kinds of medicinal and surgical management or treatment are available for the disorder. But it depends on how affected patients respond to it and how severe the disorder is. We can control most of the symptoms of achalasia.

What is the management of achalasia cardia?

The management of the disorder is achieved by medicinal or surgical ways depending on the condition of the affected patient. Please refer treatment section above.

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