When Difficulty in Swallowing Turns Out to Be Achalasia Cardia
Difficulty in swallowing, medically known as dysphagia, is a symptom that can have many possible causes. Quite often, patients are first advised to undergo an endoscopy to rule out structural problems such as ulcers, strictures, or growths in the food pipe. But what happens when the endoscopy looks completely normal, yet the patient continues to struggle with swallowing?
This is exactly what happened in a recent case.
The Patient’s Story
A patient visited me(Dr Mukesh Nandal) with persistent complaints of difficulty in swallowing food and liquids. They had already undergone an endoscopy at another center, which was reported as normal. However, the history was strongly suggestive of something deeper – a possible esophageal motility disorder, where the problem lies not in the structure of the food pipe but in how it functions.
The Right Tests Make All the Difference
To get to the root of the problem, we performed a timed barium esophagogram, a special X-ray study where the patient drinks a contrast solution while images are taken to see how well the esophagus pushes food downward. Along with this, we carried out esophageal manometry, which measures the pressure and movement within the food pipe.
Both these tests confirmed the diagnosis of Achalasia Cardia.
What is Achalasia Cardia?
Achalasia Cardia is a rare but important condition where the lower end of the esophagus (the valve connecting the food pipe to the stomach) fails to relax properly. As a result, food and liquids have difficulty passing into the stomach, leading to symptoms such as:
- Difficulty in swallowing both solids and liquids
- Regurgitation of undigested food
- Chest pain or heaviness
- Unexplained weight loss
- Frequent nighttime cough or choking sensation
Since endoscopy often looks normal in these patients, many cases remain undiagnosed until further tests are done.
Why Second Opinions Matter
This case is a reminder that not all swallowing difficulties are explained by routine tests. When symptoms persist, advanced diagnostic tools like barium studies and manometry are essential. Seeking a second opinion can make all the difference in reaching the right diagnosis and starting timely treatment.
Treatment Options
While Achalasia Cardia cannot be completely cured, effective treatments are available to relieve symptoms and improve quality of life. These include:
- Pneumatic dilation (stretching the tight valve)
- Laparoscopic Heller’s Myotomy (surgical cutting of the valve muscle)
- POEM (Peroral Endoscopic Myotomy), a minimally invasive endoscopic procedure
- Medications or Botox injections in selected cases
Conclusion:
If you or someone you know has persistent swallowing difficulties, do not ignore them. A normal endoscopy does not always mean everything is fine. Advanced tests and timely diagnosis can uncover hidden conditions like Achalasia Cardia and lead to the right treatment.
