Dr. Samhitha Reddy
Consultant Proctologist & Laparoscopic Surgeon
MBBS, MS, FMAS, FISCP, DMAS
- 8 Yrs
- ASCRS Member
Surgical Gastroenterology · Oesophagus
Achalasia Cardia Treatment in Hyderabad: Swallowing Restored at Lux Hospitals
Achalasia is a rare swallowing disorder in which the valve at the bottom of the oesophagus fails to relax, so food and liquid cannot pass into the stomach. It is frequently mistaken for reflux for years before it is correctly identified.
The distinction matters, because acid-suppressing medication does nothing for it. Our gastrointestinal surgeons at Lux Hospitals, HITEC CITY diagnose achalasia with manometry and treat it with POEM or laparoscopic Heller’s myotomy: procedures that divide the tight muscle and restore normal swallowing.
- Manometry-Confirmed Diagnosis
- POEM & Heller’s Myotomy
- Lasting Relief
What is Achalasia Cardia?
Achalasia cardia is a disorder in which the lower oesophageal sphincter, the muscular valve where the oesophagus joins the stomach, fails to relax when you swallow. At the same time the oesophagus above it loses its normal coordinated squeezing. Food and liquid therefore collect above the closed valve instead of passing through.
The underlying problem is nerve loss. The specialised nerve cells in the oesophageal wall that would normally signal the sphincter to open degenerate, and once lost they do not regenerate. This is why every treatment for achalasia is mechanical: the muscle is stretched, weakened or divided, because the nerve control cannot be restored.
Manometry divides it into three types, and the distinction guides treatment. Type II, with pressurisation along the oesophagus, responds best to any treatment. Type I with an already-dilated oesophagus responds less well, and Type III, the spastic form, responds particularly well to POEM because a longer myotomy can be made.
Causes of Achalasia Cardia
The nerve degeneration that causes achalasia is not fully explained. Several contributing mechanisms are recognised.
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Degeneration of oesophageal nerves
Loss of the ganglion cells in the myenteric plexus that coordinate swallowing and signal the sphincter to relax. This is the core lesion.
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Autoimmune response
Evidence points to an immune-mediated attack on those nerve cells, and achalasia is commoner in people with other autoimmune conditions.
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Viral infection
Herpes, measles and other viral infections have been implicated as triggers for the immune response in genetically susceptible people.
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Genetic factors
Rare familial forms exist, and achalasia occurs as part of inherited syndromes such as Allgrove syndrome.
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Chagas disease
Infection with Trypanosoma cruzi destroys the same nerve cells and produces an identical picture, though it is confined to South America.
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Pseudoachalasia
A tumour at the gastro-oesophageal junction can mimic achalasia exactly. It is the crucial diagnosis to exclude, particularly in older patients.
For most patients no specific cause is ever identified. What matters clinically is excluding pseudoachalasia, because a tumour causing the same symptoms needs entirely different treatment.
Symptoms of Achalasia Cardia
The hallmark that distinguishes achalasia from almost everything else is difficulty swallowing liquids as well as solids, from early on.
Core symptoms
- Difficulty swallowing both solids and liquids
- Regurgitation of undigested food, often hours after eating
- Chest pain or a sensation of pressure behind the breastbone
- A feeling of food sticking in the chest
- Heartburn that does not respond to acid-suppressing medication
- Needing to drink water to push food down, or to stand up while eating
As it progresses
- Unexplained and progressive weight loss
- Persistent cough at night from regurgitation while lying flat
- Choking episodes during sleep
- Recurrent chest infections from aspiration
- Fever and breathlessness suggesting aspiration pneumonia
- Severe chest pain or repeated vomiting
Difficulty with liquids from the outset is the giveaway. A mechanical obstruction such as a stricture or tumour causes trouble with solids first, and liquids only much later: achalasia does not follow that pattern.
How Achalasia is Diagnosed
Achalasia is diagnosed on manometry. Endoscopy and a barium swallow support it, and endoscopy has the separate job of excluding a tumour.
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High-resolution manometry
The definitive test. It measures pressures along the oesophagus, confirms the sphincter fails to relax, and classifies the type, which guides treatment.
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Barium swallow
Shows the classic tapering "bird’s beak" at the lower oesophagus, with dilatation above it and delayed emptying of contrast.
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Upper GI endoscopy
Excludes a tumour at the junction mimicking achalasia, and assesses retained food, candida and the state of the mucosa.
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Timed barium oesophagram
Measures how much contrast remains after one and five minutes, giving an objective figure to compare against after treatment.
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CT chest
Where pseudoachalasia is suspected, to look for a tumour outside the oesophagus compressing the junction.
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Eckardt score
A simple score combining dysphagia, regurgitation, chest pain and weight loss. It quantifies severity and tracks response objectively.
Achalasia is commonly misdiagnosed as reflux for years, and treated with acid suppression that cannot help. Manometry is what settles it, and it is worth asking for if the picture fits.
Treatment Options for Achalasia Cardia
No treatment restores the lost nerves. Every option works by reducing the resistance at the sphincter so gravity and residual contractions can move food through.
Non-surgical
Non-surgical treatment
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Muscle-relaxing medication
Calcium channel blockers and nitrates relax the sphincter modestly. Effects are limited and short-lived, so this is reserved for patients unfit for anything else.
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Botox injection
Botulinum toxin injected into the sphincter endoscopically relaxes it for around six to twelve months. Useful for frail or elderly patients, but repeated injections scar the tissue and make later surgery harder.
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Pneumatic balloon dilation
A balloon is inflated across the sphincter to tear the muscle fibres. Effective, and often needs repeating. There is a small risk of perforation, which is why it is done where surgical backup exists.
Procedural
Myotomy: the definitive treatments
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POEM
Per-Oral Endoscopic Myotomy. The muscle is divided from inside the oesophagus through an endoscope, with no external incision at all. Excellent results, and the treatment of choice for Type III achalasia because the myotomy can be extended as far as needed.
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Laparoscopic Heller’s myotomy
The muscle is divided from outside through keyhole incisions. The long-established gold standard, with durable results over decades of follow-up.
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Heller’s myotomy with fundoplication
A partial wrap added at the same operation. Dividing the sphincter removes the barrier to reflux, and the wrap restores it, which is why this combination is standard.
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Robotic-assisted myotomy
The same operation with robotic instrumentation, giving finer control when dividing muscle fibres against a thin mucosa.
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Oesophagectomy
Removal of the oesophagus, reserved for end-stage disease with a massively dilated, sigmoid-shaped oesophagus that no myotomy will help.
POEM and Heller’s myotomy give comparable relief of swallowing. The trade-off is reflux: POEM has no anti-reflux component and causes more of it, while Heller’s with a partial wrap causes less. That choice is made with you.
What POEM Involves
A one to two hour endoscopic procedure done entirely through the mouth. No external incisions, no scars, and a one to two night stay.
Per-Oral Endoscopic Myotomy
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Pre-procedure preparation
A liquid diet for two days beforehand so the oesophagus is empty: retained food would make the procedure unsafe. Antibiotics are given at induction.
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Anaesthesia
General anaesthetic with the airway protected, since retained oesophageal contents carry a real risk of aspiration.
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Creating the mucosal entry
A small incision is made in the inner lining of the oesophagus, around ten centimetres above the sphincter, to enter the wall.
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Tunnelling down the wall
A submucosal tunnel is created between the inner lining and the muscle layer, extending down past the sphincter into the upper stomach.
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Dividing the muscle
The circular muscle fibres are divided along the length of the tunnel, including across the sphincter. Myotomy length is tailored to the achalasia type.
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Closing the entry
The mucosal entry point is closed with clips or sutures. The intact mucosa over the myotomy is what keeps the chest sealed from the oesophagus.
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Recovery and discharge
A contrast swallow the next day to confirm no leak, then fluids, and home after one to two nights on a graded diet.
Because the sphincter no longer closes, reflux is common after POEM and most patients need long-term acid-suppressing medication. That is a straightforward trade for being able to swallow normally.
Why Choose Lux Hospitals for Achalasia Treatment?
Achalasia is uncommon, frequently misdiagnosed, and needs specialist testing to identify. Here is why patients trust us:
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Advanced diagnostics
High-resolution manometry, endoscopy and timed barium studies, so the diagnosis is confirmed and typed rather than assumed.
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Experienced specialists
Led by Dr. Tagore Mohan Grandhi, with extensive experience in POEM, laparoscopic myotomy and complex oesophageal surgery.
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Comprehensive care
From the first consultation through to post-treatment follow-up, with one team throughout.
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Convenient location
Our hospital is in HITEC CITY, near IKEA: easily reachable from across Hyderabad.
Recovery & Aftercare
Recovery after minimally invasive treatment takes one to two weeks. The diet is graded deliberately while the myotomy heals.
- Day 0–1
Nil by mouth overnight. A contrast swallow the next morning confirms there is no leak before anything is given by mouth.
- Days 2–7
Home on a liquid diet, progressing to soft foods. Most patients notice swallowing is dramatically easier straight away.
- Weeks 2–4
Soft then normal textures, small mouthfuls, chewed well. Desk work resumes from around week two. Acid-suppressing medication starts.
- Weeks 4–8
Normal diet restored. Weight lost before treatment begins to return. Full activity including the gym resumes.
- Months 3–12
Review with a repeat Eckardt score, and manometry or a timed barium study where symptoms warrant, to confirm objective improvement.
Aftercare
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Take acid suppression
A proton pump inhibitor long term, particularly after POEM. The sphincter no longer closes, so reflux is expected rather than a complication.
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Eat slowly, sit upright
Small mouthfuls, chewed thoroughly, and stay upright for two to three hours after eating to let gravity help.
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Avoid late meals
Nothing within three hours of lying down. This reduces both reflux and the risk of aspirating retained food at night.
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Raise the head of your bed
By fifteen to twenty centimetres. It genuinely reduces night-time reflux and regurgitation.
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When to call us
Fever, severe chest pain, breathlessness, or difficulty swallowing that returns after initially improving.
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Long-term surveillance
Achalasia carries a small increased risk of oesophageal cancer over decades, so periodic endoscopic surveillance is recommended.
Treatment relieves the obstruction but does not restore the lost nerves: the oesophagus never regains normal coordinated squeezing. Symptoms can gradually return over years, and repeat treatment is sometimes needed.
When Should You See a Doctor?
Book a consultation if any of the following apply.
- Difficulty swallowing solids and liquids that is getting worse.
- Regurgitation of undigested food, particularly at night.
- Severe chest pain or repeated vomiting.
- Significant unexplained weight loss.
- Fever with cough or breathlessness: possible aspiration.
- Heartburn that has not responded to acid-suppressing medication.
Cost of Achalasia Treatment in Hyderabad
Cost depends on which treatment is chosen. These are the ranges our patients fall into.
| Procedure | Estimated Cost |
|---|---|
| Consultation & assessment Per visit | ₹1,000 – ₹2,000 |
| High-resolution manometry The diagnostic test, out-patient | ₹10,000 – ₹18,000 |
| Endoscopy & barium swallow Combined diagnostic workup | ₹10,000 – ₹20,000 |
| Botox injection Day care, effect lasts 6–12 months | ₹35,000 – ₹60,000 |
| Pneumatic balloon dilation Day care or one night; may need repeating | ₹55,000 – ₹95,000 |
| POEM One to two nights’ stay, no external incision | ₹2,20,000 – ₹3,80,000 |
| Laparoscopic Heller’s myotomy with fundoplication Two to three nights’ stay | ₹2,00,000 – ₹3,50,000 |
What changes the estimate
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Which treatment is chosen
Botox and dilation cost far less but need repeating. A myotomy costs more once and lasts for years.
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Achalasia type and severity
Type III needs a longer myotomy and a longer procedure. An end-stage sigmoid oesophagus is a different operation altogether.
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Previous treatments
Repeated Botox injections scar the plane surgeons need to work in, making a later myotomy longer and more difficult.
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Room category
A shared ward, a twin-sharing room or a private suite: the largest single swing in most estimates.
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Insurance & TPA cover
We are empanelled with most major insurers, and our team files the pre-authorisation for you.
Every figure above is an indicative range, not a quote. After your consultation you are given a written, fixed-cost estimate, and that is the number you pay, with no additions once treatment begins.
Other Bariatric Treatments
Our Surgeons
Achalasia Cardia Specialists at Lux Hospitals
The gastrointestinal surgeon who treats achalasia and oesophageal disorders at our HITEC CITY hospital.
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Dr. Tagore Mohan Grandhi
Senior Consultant: Bariatric & Gastrointestinal Surgery
MBBS, MS, FRCS (UK), DLS (France)
28 years experience
Testimonials
What Patients Say About Their Treatment
Reviews from patients treated for gastrointestinal conditions at Lux Hospitals, Hyderabad.
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Got Questions?
Frequently Asked Questions
Common questions about achalasia cardia, its treatment, and what care costs at Lux Hospitals.
What are the types of achalasia cardia?
High-resolution manometry defines three types. Type I has minimal pressurisation and an often already-dilated oesophagus. Type II shows pressurisation along the whole oesophagus and responds best to any treatment. Type III is the spastic form, and responds particularly well to POEM because a longer myotomy can be made.
What is the best treatment for achalasia?
POEM and laparoscopic Heller’s myotomy are the two definitive treatments, with comparable relief of swallowing. POEM has no external incision and suits Type III particularly well; Heller’s with a partial fundoplication causes less reflux afterwards. Botox and dilation are alternatives for patients unfit for either.
What causes achalasia?
It results from degeneration of the nerve cells in the oesophageal wall that signal the sphincter to relax. The cause of that degeneration is usually unknown, though an autoimmune response, possibly triggered by a viral infection in genetically susceptible people, is the leading explanation.
Is achalasia treatment permanent?
A myotomy is durable and lasts many years in most patients, but it is not strictly permanent: the underlying nerve damage cannot be reversed, so symptoms can gradually return over time and repeat treatment is sometimes needed. Botox and dilation are explicitly temporary.
Why is achalasia often mistaken for acid reflux?
Both cause heartburn and chest discomfort, and food retained in the oesophagus can ferment and taste acidic. The key difference is that achalasia causes difficulty swallowing liquids as well as solids from early on, and does not respond to acid-suppressing medication. Manometry settles it.
Will I get reflux after treatment?
Very likely, particularly after POEM. Dividing the sphincter removes the barrier that prevents reflux, so most patients need long-term acid-suppressing medication afterwards. A Heller’s myotomy with a partial fundoplication reduces this, which is why the wrap is added.
Is achalasia surgery safe?
Yes, in experienced hands. Both POEM and laparoscopic Heller’s myotomy have high success rates and low complication rates. The main risks are perforation of the mucosa during the procedure (usually repaired immediately) and reflux afterwards.
Does achalasia increase the risk of cancer?
There is a small increased risk of oesophageal cancer over several decades, related to chronic irritation from retained food. It remains uncommon, but it is the reason periodic endoscopic surveillance is recommended long term even after successful treatment.
How much does achalasia treatment cost in Hyderabad?
POEM at Lux Hospitals ranges from about ₹2,20,000 to ₹3,80,000, and laparoscopic Heller’s myotomy with fundoplication from ₹2,00,000 to ₹3,50,000. Pneumatic dilation is ₹55,000–₹95,000 and Botox ₹35,000–₹60,000. Diagnostic manometry is ₹10,000–₹18,000.
How can I book an appointment for achalasia treatment at Lux Hospitals?
You can book an appointment by calling us, messaging us on WhatsApp, or walking into Lux Hospitals, HITEC CITY.
Still have questions? Call us at 079 6908 4422
Still have questions? Message us on WhatsApp at 079 6908 4444
Book Your Achalasia Consultation in Hyderabad
Manometry-confirmed diagnosis and definitive treatment for achalasia, with a fixed-cost estimate before treatment begins.
Plot No.116, Lumbini Avenue, HITEC CITY, Near IKEA, Hyderabad – 500032