Achalasia Cardia (Heller Myotomy) | Pristyn Care

Risk Factors

Risk factors include:

• Age 25-60 years (peak incidence)
• Autoimmune conditions
• Family history of achalasia
• Chagas disease (in South American populations, caused by Trypanosoma cruzi)
• Prior oesophageal or gastric surgery

Who Is at Risk

Adults aged 25-60 years, individuals with autoimmune conditions, and those from endemic areas of Chagas disease are most at risk for achalasia. Both sexes are equally affected and there is no strong lifestyle risk factor.

Diagnosis

Diagnostic evaluation includes:

• High-resolution oesophageal manometry (gold standard) showing absent LES relaxation
• Barium swallow showing birds-beak appearance and oesophageal dilation
• Upper GI endoscopy to exclude pseudoachalasia (malignancy)
• CT chest for oesophageal dilation and mediastinal assessment
• Timed barium oesophagram for treatment response monitoring

Treatment for Achalasia Cardia

Pristyn Care performs laparoscopic Heller myotomy with Dor anterior fundoplication, achieving excellent long-term symptom relief with low recurrence and minimal reflux risk in achalasia patients.

Heller Myotomy Procedure

Surgical procedure involves:

• Laparoscopic approach with 5 ports under general anaesthesia
• Dissection of the oesophagogastric junction and lower oesophagus
• Division of the circular and longitudinal muscle fibres (myotomy) extending 6 cm up the oesophagus and 2-3 cm onto the stomach
• Intraoperative endoscopy to confirm complete myotomy and exclude mucosal injury
• Dor anterior fundoplication (180 degree) to prevent reflux and cover myotomy
• Drain placement and port closure
• Operative time approximately 90-120 minutes

After the Surgery

Post-operative care includes:

• Liquid diet for 24-48 hours post-op progressing to soft foods at 2 weeks
• Proton pump inhibitor therapy for 3-6 months
• Avoidance of spicy, acidic, and hard foods initially
• Follow-up timed barium swallow at 3 months to assess treatment response
• High-resolution manometry at 12 months if symptoms persist
• Long-term endoscopic surveillance for oesophageal cancer risk

Possible Complications of Heller Myotomy

Potential complications include:

• Mucosal perforation during myotomy (repaired intraoperatively)
• Gastro-oesophageal reflux (managed by fundoplication)
• Incomplete myotomy requiring repeat intervention
• Recurrent dysphagia requiring dilation or redo surgery
• Oesophageal cancer (long-term risk from stasis and Barrett’s oesophagus)