Achalasia Cardia Treated with POEM: A Patient Journey and Case Study
Achalasia cardia is a rare swallowing disorder in which the oesophagus loses its ability to push food down and the valve at its lower end does not relax. It is confirmed with high-resolution manometry, supported by a barium swallow and an endoscopy. Peroral endoscopic myotomy (POEM) is one established, minimally invasive treatment, alongside pneumatic dilation and laparoscopic Heller myotomy.
This article follows one patient, a working mother living in the UK, through more than two years of worsening difficulty swallowing, a 13 kg weight loss and long diagnostic waits, to treatment with POEM. It is shared for awareness, with the patient’s consent and with identifying details removed. Individual results vary.
- Main symptom: difficulty swallowing both solids and liquids (dysphagia)
- Key test: high-resolution oesophageal manometry
- Procedure in this case: POEM, about one hour, with a planned hospital stay of two to three days
- Outcome reported by the patient: able to eat solid and liquid food again
The patient’s journey: from “I couldn’t eat” to eating normally again
When swallowing became a struggle
In 2019, a busy single mother of three living in London began having trouble swallowing. It happened with every kind of food, solid or semi-liquid. She did not know why, and it slowly began to affect her work and her daily routine.
Her family doctor advised a camera test (endoscopy). The COVID-19 pandemic then made specialist appointments and tests hard to get. When a barium swallow test was finally done, it pointed to achalasia cardia.
More than a year of waiting
She then waited more than a year for an endoscopy and a specialist review. Over this time she lost about 13 kg. She became anaemic and developed nutritional deficiencies.
She began carrying a large bottle of water everywhere, because she could not get food down without it. She stopped eating out, lost confidence and was on sick leave for a long period.
I was not able to go anywhere, eat anything without water.
The patient
What her family saw
While visiting her son in Australia, he noticed how much weight she had lost since he last saw her. An endoscopy arranged there confirmed achalasia. She was advised to have oesophageal manometry and a POEM procedure, done by an experienced team because the condition is rare.
The family joined several achalasia support groups and spoke to general physicians. Local waiting times were around four months for manometry alone, with surgery further away. Her doctors advised treatment as early as possible because of her weight loss and anaemia.
Her son described what helped most as a family: a clear explanation of the condition, the reason for each test, and a plan they could follow. That made it possible to arrange travel and finances with confidence.
Travelling for treatment
Through a personal contact, she was referred to Dr. Sukrit Singh Sethi, Senior Consultant – Gutwell Gurgaon and Consultant – Hepatology, Liver Transplantation and Medical Gastroenterology at Narayana Superspeciality Hospital, Gurgaon. The first discussion took place by phone from abroad, covering how the procedure is done and the expected two-to-three-day stay.
After arriving in India, she had manometry and pre-operative checks. POEM was performed on the day of admission and took about an hour. She was then moved to her room to recover.
The family noted that, as overseas visitors, clear signage, a defined admission process and approachable staff made an unfamiliar hospital easier to navigate.
Life after treatment
After the procedure, she reported being able to eat solid and liquid food again, something she had not managed for a long time.
My life has again become so normal.
The patient
Her story is one person’s experience. It is shared to help people with long-standing swallowing difficulty recognise that achalasia is a diagnosable and treatable condition.
What is achalasia cardia?
Achalasia cardia is a rare disorder of the oesophagus (food pipe). The nerves that coordinate swallowing are damaged, so the oesophagus stops squeezing food downward and the lower oesophageal sphincter (LES) stays tight. Food and liquid collect above the valve instead of passing into the stomach.
It affects roughly 1 in 100,000 people each year. It can appear at any age, most often between 25 and 60, and affects men and women about equally. The exact cause is usually unknown.
- Muscle waves push food downward
- The lower valve (LES) relaxes when you swallow
- Food passes smoothly into the stomach
- Nerve damage stops the muscle waves
- The LES stays tight and does not relax
- Food and liquid collect above the valve
Common symptoms of achalasia
Because the symptoms overlap with heartburn, achalasia is sometimes first treated as reflux. Learn how true acidity and GERD differ, and which digestive warning signs should not be ignored.
When to see a doctor
See a doctor, ideally a gastroenterologist, if you have difficulty swallowing that lasts more than a few weeks, keeps getting worse, or comes with weight loss.
How is achalasia diagnosed?
Achalasia is diagnosed with three complementary tests; high-resolution manometry is the one that confirms it.
| Test | What it involves | What it shows in achalasia |
|---|---|---|
| High-resolution oesophageal manometry | A thin tube through the nose measures pressure along the oesophagus during swallows | LES fails to relax and normal muscle waves are absent; also classifies the subtype (I, II or III) |
| Barium swallow (timed) | X-rays taken after drinking a contrast liquid | A widened oesophagus narrowing to a “bird’s beak” at the bottom, with slow emptying |
| Upper GI endoscopy | A camera examines the oesophagus and stomach | Retained food or fluid; rules out other causes, especially a tumour near the stomach (pseudo-achalasia) |
In this case, the barium swallow suggested achalasia, endoscopy confirmed the picture, and manometry was completed before treatment. For more on the camera test itself, read what an endoscopy doctor does.
Achalasia cardia treatment options, including POEM
No treatment repairs the damaged nerves; all options aim to relieve the tight valve so food can pass. The right choice depends on the achalasia subtype, age, overall health, previous treatment and patient preference.
| Treatment | How it works | Typical considerations |
|---|---|---|
| POEM (peroral endoscopic myotomy) | Through an endoscope in the mouth, the doctor tunnels under the oesophageal lining and cuts the tight muscle | No external cuts; can extend the cut for type III; higher chance of acid reflux afterwards |
| Laparoscopic Heller myotomy with fundoplication | Keyhole surgery cuts the muscle from outside and adds an anti-reflux wrap | Long track record; small abdominal incisions; general surgery recovery |
| Pneumatic balloon dilation | A balloon stretches and tears the LES muscle | No surgery; may need repeat sessions; small risk of perforation |
| Botulinum toxin injection | Relaxes the LES temporarily | Effect usually lasts months; mainly for people unfit for other options |
| Medicines | Calcium-channel blockers or nitrates relax smooth muscle | Limited, short-term relief; side effects are common |
What to expect with POEM
POEM is done under general anaesthesia and usually takes one to two hours. Many patients start liquids the next day and go home within one to three days. Studies report good symptom relief in about 85–95% of patients in the first years.
Possible risks of POEM
Like any procedure, POEM has risks. These are explained before consent:
- Gastro-oesophageal reflux (acid reflux), which is common and often needs long-term medication
- Bleeding, or a tear in the oesophageal lining
- Air collecting in the chest or abdomen, usually minor and self-limiting
- Return of symptoms over time, which may need further treatment
POEM needs specialised training and experience. Ask your gastroenterologist how the options compare for your situation. If reflux develops after treatment, it is usually managed in the same way as GERD treatment for acid reflux.
Case study: achalasia cardia with significant weight loss treated by POEM
An adult woman with progressive dysphagia, 13 kg weight loss and anaemia, after a prolonged diagnostic delay, reported resumption of a normal oral diet following POEM.
| Parameter | Details |
|---|---|
| Patient | Adult female, UK resident, overseas patient (identity withheld) |
| Presenting complaint | Progressive dysphagia to solids and semi-liquids since 2019 |
| Associated features | About 13 kg weight loss, anaemia, nutritional deficiencies, dependence on water to swallow, prolonged sick leave |
| Initial investigation | Barium swallow suggestive of achalasia |
| Further investigation | Upper GI endoscopy (abroad) consistent with achalasia |
| Confirmatory test | High-resolution oesophageal manometry before treatment |
| Diagnostic delay | More than one year, linked to pandemic-related service backlogs |
| Procedure | Peroral endoscopic myotomy (POEM) |
| Procedure duration | About 1 hour |
| Planned hospital stay | 2–3 days |
| Reported outcome | Tolerating solid and liquid diet; return to normal daily activity |
Clinical course
- Dysphagia to both solids and liquids from the start should raise suspicion of a motility disorder such as achalasia.
- Delayed diagnosis can lead to marked weight loss, anaemia and loss of work capacity.
- Endoscopy is essential to exclude pseudo-achalasia, especially with rapid weight loss.
- Manometry confirms the diagnosis and its subtype, which guides the choice of treatment.
- Remote counselling before travel helped an overseas patient plan treatment with clear expectations.
- Long-term follow-up is advised after POEM to monitor for reflux and symptom recurrence.
Frequently asked questions about achalasia and POEM
Is achalasia cardia curable?
Achalasia cannot be fully cured because the nerve damage is permanent. Treatments such as POEM, Heller myotomy and balloon dilation can relieve symptoms for many years, so most people return to eating normally.
What is the POEM procedure for achalasia?
POEM (peroral endoscopic myotomy) is a minimally invasive procedure performed through the mouth with an endoscope. The tight muscle at the lower end of the oesophagus is cut from the inside, with no cuts on the skin.
How long is the hospital stay after POEM?
Most patients stay one to three days. Liquids are usually started the day after the procedure, followed by a soft diet for a short period.
Is POEM better than Heller myotomy?
Neither is better for everyone. Both give similar symptom relief in studies. POEM avoids skin incisions and suits type III achalasia, but carries a higher chance of acid reflux. Heller myotomy usually includes an anti-reflux wrap.
What tests are needed before POEM?
High-resolution manometry, upper GI endoscopy and usually a barium swallow. Routine blood tests and an anaesthesia assessment are also done.
What are the side effects of POEM?
The most common is acid reflux, which is often managed with medication. Less common risks include bleeding, a mucosal tear and air in the chest or abdomen.
Can achalasia be mistaken for acid reflux?
Yes. Regurgitation and chest discomfort can resemble reflux. Achalasia should be considered when reflux medicines do not help and swallowing liquids is also difficult.
Can international patients get achalasia treatment in India?
Yes. Many centres in India offer manometry and POEM. An initial teleconsultation can help plan tests, travel and the length of stay.
Disclaimer: This article is for general health education only. It is not a substitute for a consultation, diagnosis or treatment by a qualified doctor. The patient’s experience is shared with written consent, with identifying details removed. Outcomes differ from person to person, and no result is guaranteed. Every procedure carries risks, which should be discussed with your treating doctor.
References
- Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG Clinical Guidelines: Diagnosis and Management of Achalasia. Am J Gastroenterol. 2020;115(9):1393–1411. PubMed 32773454
- Khashab MA, Vela MF, Thosani N, et al. ASGE guideline on the management of achalasia. Gastrointest Endosc. 2020;91(2):213–227. ASGE
- Oude Nijhuis RAB, Zaninotto G, Roman S, et al. European guidelines on achalasia: United European Gastroenterology and European Society of Neurogastroenterology and Motility recommendations. United European Gastroenterol J. 2020;8(1):13–33. doi:10.1177/2050640620903213
