Achalasia (Achalasia Cardia) Treatment in Hyderabad

Achalasia is an uncommon disorder of the esophagus in which the muscle at its lower end — the lower esophageal sphincter — doesn't relax properly, and the esophagus itself loses the coordinated muscle contractions that normally push food downward. The result is food and liquid building up rather than passing smoothly into the stomach. It's frequently mistaken for GERD in its early stages, which can delay proper diagnosis. At KAGE, achalasia is diagnosed through esophageal function testing, classified by subtype, and treated with POEM — a modern, non-surgical endoscopic procedure matched to the specific pattern of disease.

• Type I (classic) — minimal contractility in the esophagus; often more advanced disease at diagnosis
• Type II — pan-esophageal pressurization; generally has the best response rates to treatment, including POEM
• Type III (spastic) — spastic esophageal contractions; more complex to treat and typically requires a longer myotomy

Manometry findings determine the subtype, which meaningfully influences which treatment — and which extent of myotomy — is likely to work best.

• Difficulty swallowing solids and, as it progresses, liquids too (dysphagia)
• Regurgitation of undigested food, sometimes during sleep
• Chest pain or a sensation of food sticking behind the breastbone
• Unintended weight loss
• Heartburn-like symptoms that don't respond to usual reflux medication

• Esophageal manometry — the primary test; determines the Chicago Classification subtype
• Barium swallow study — shows the characteristic narrowing and poor emptying
• Upper GI endoscopy — to rule out other causes such as a tumor causing similar symptoms

• POEM (Peroral Endoscopic Myotomy) — performed entirely through the mouth, cutting the tight muscle fibers from the inside with no external incisions; particularly effective for Type II, and increasingly preferred for Type III given the ability to perform a longer, more tailored myotomy
• Pneumatic balloon dilation — a non-surgical option for select patients, often Type I or II
• Laparoscopic Heller myotomy — the traditional surgical approach, still appropriate in some cases
• Botulinum toxin injection — typically reserved for patients who aren't candidates for the procedures above, given its temporary effect

POEM achieves a similar muscle-cutting result to Heller's myotomy but through an endoscope rather than external incisions, meaning no visible scars, generally less post-procedure pain, and a faster return to normal activity. One important trade-off to discuss with your gastroenterologist: because POEM cuts through some of the same muscle that normally helps prevent reflux, a portion of patients develop new or worsened GERD symptoms afterward — manageable with medication, and part of why post-procedure follow-up matters.

Achalasia is confirmed on high-resolution manometry, not on endoscopy alone, and the treatment choice follows the subtype the manometry shows. Our gastroenterologists perform POEM and pneumatic dilation, and review patients who have already had one treatment and whose symptoms have returned. If swallowing has become difficult or food regurgitates undigested, book a consultation to have your symptoms and previous tests reviewed.