OESOPHAGEAL MOTILITY DISORDER · CONDITION GUIDE

Achalasia Cardia

Q: Is achalasia curable with surgery?

Laparoscopic Heller myotomy achieves excellent long-term symptom control in over 90% of patients. While achalasia is not cured in the strictest sense, myotomy reliably relieves obstruction and restores comfortable swallowing.

Q: What is the difference between Heller myotomy and POEM?

Both procedures divide the lower oesophageal sphincter muscle. Heller myotomy is performed laparoscopically through small abdominal incisions with the addition of an anti-reflux wrap. POEM is an endoscopic procedure performed entirely through the mouth without external incisions, but carries a higher risk of post-procedure reflux.

Q: How long does improvement last after myotomy?

The majority of patients maintain excellent swallowing function at 10 years following laparoscopic Heller myotomy. Some patients may develop recurrent symptoms over time and may require re-treatment with dilatation or repeat myotomy.

A motility disorder of the oesophagus causing progressive difficulty swallowing due to failure of the lower oesophageal sphincter to relax — treated surgically with myotomy.

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Rare PREVALENCE

60–90 Min PROCEDURE DURATION

1–2 Days HOSPITAL STAY

ABOUT THIS CONDITION

What is Achalasia Cardia?

Achalasia cardia is a primary oesophageal motility disorder characterised by failure of the lower oesophageal sphincter (LES) to relax during swallowing, combined with absent peristalsis in the oesophageal body. This results in progressive dysphagia (difficulty swallowing), regurgitation of undigested food, chest pain, and weight loss. The underlying cause is loss of inhibitory neurons in the oesophageal myenteric plexus. Dr. Tagore Mohan Grandhi performs laparoscopic Heller myotomy for achalasia at Lux Hospitals, Hyderabad. This procedure divides the thickened circular muscle fibres of the lower oesophageal sphincter, relieving obstruction and restoring swallowing function. A partial fundoplication is added to prevent post-operative reflux.

SIGNS TO WATCH

Common Symptoms

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Symptoms that need attention

Progressive difficulty swallowing both solids and liquids Regurgitation of undigested food, particularly at night Chest pain or discomfort after meals Unintentional weight loss due to inadequate intake Frequent episodes of coughing or aspiration Sensation of food sticking behind the breastbone

WHY IT HAPPENS

Causes & Risk Factors

Loss of inhibitory nerve cells in the oesophageal myenteric plexus
Possible autoimmune or viral aetiology in susceptible individuals
Genetic predisposition in rare familial cases
Degeneration of ganglion cells leading to unopposed LES contraction
Secondary achalasia from oesophageal or gastric cancer (pseudoachalasia)
Long-standing inflammation affecting oesophageal nerve supply

CLINICAL DETAILS

KeyFacts

Diagnosis

Oesophageal manometry, barium swallow, and endoscopy

Surgical Option

Laparoscopic Heller myotomy with partial fundoplication

Success Rate

Over 90% improvement in swallowing with myotomy

Recovery

Soft diet for 2–4 weeks; return to normal in 3–4 weeks

Alternative

Pneumatic dilatation or POEM (Per-Oral Endoscopic Myotomy)

Hospital

Available at Lux Hospitals, Hitech City, Hyderabad

HOW WE TREAT IT

Treatment Approach

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Laparoscopic Heller Myotomy

Laparoscopic Heller myotomy is the gold-standard surgical treatment for achalasia. Dr. Grandhi divides the lower oesophageal sphincter muscle fibres laparoscopically, relieving obstruction and restoring swallowing with excellent long-term outcomes. A partial fundoplication is added to prevent post-operative acid reflux.

Available at Lux Hospitals, Hitech City, Hyderabad

1

Diagnosis & Assessment

High-resolution oesophageal manometry confirms the diagnosis. Barium swallow demonstrates the characteristic ‘bird’s beak’ appearance. Endoscopy excludes pseudoachalasia and assesses mucosal integrity.
2

Treatment Planning

Achalasia type (I, II, or III) is determined on manometry, as this influences treatment response. Laparoscopic Heller myotomy with partial fundoplication is planned for suitable surgical candidates.
3

Laparoscopic Heller Myotomy

Under general anaesthesia, the circular and longitudinal muscle fibres of the lower oesophageal sphincter are divided laparoscopically. A Dor or Toupet partial fundoplication is added to prevent reflux.
4

Recovery & Dietary Progression

Clear fluids commenced on day one. A soft diet is maintained for 2–4 weeks. Most patients are discharged within 1–2 days and experience significant improvement in swallowing within weeks.

AVAILABLE TREATMENTS

TreatmentOptions

Laparoscopic Heller Myotomy

Laparoscopic division of the lower oesophageal sphincter muscle with partial fundoplication. Gold-standard surgical treatment for achalasia with over 90% long-term efficacy.

Heller Myotomy (Open)

Open surgical myotomy for cases where laparoscopic access is not feasible or where previous surgery has created significant adhesions.

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COMMON QUESTIONS

Frequently Asked Questions

Is achalasia curable with surgery?+

What is the difference between Heller myotomy and POEM?+

How long does improvement last after myotomy?+

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