INTRODUCTION
Achalasia, a rare motor neuron disorder, presents an annual incidence of
1 per 100,000 individuals and a prevalence of 10 per 100,000.1 It is characterized by the degeneration of
inhibitory ganglion cells within the esophageal myenteric plexus and the
lower esophageal sphincter (LES), leading to a loss of inhibitory
neurons and resulting in the absence of peristalsis with failure of LES
relaxation .2 Literature suggests a multifactorial
origin of achalasia, implicating infectious agents, autoimmune
responses, and genetic factors as potential triggers
.3 While achalasia affects males and females equally,
slightly higher rates in females have been
reported.4,5 The hallmark symptom associated with
achalasia is slowly progressive dysphagia for both solids and liquids,
experienced by the majority of affected patients, accompanied by
regurgitation, heartburn, and non-cardiac chest pain
.6,7
Diagnosis of achalasia relies on peculiar clinical symptoms and imaging
studies such as barium swallow and esophageal manometry
.8 A barium esophagogram reveals classic findings like
the ”bird’s beak” appearance and esophageal dilation which serve as the
primary diagnostic tool .9 Esophageal manometry is the
gold standard method demonstrating absent peristalsis . Upper endoscopy
is further recommended to exclude malignancy.10Treatment strategies encompass both nonsurgical options like
pharmacotherapy ( calcium channel blockers, nitrates, and botulinum
toxin) and surgical techniques such as pneumatic dilation, laparoscopic
Heller’s myotomy, and per-oral endoscopic myotomy(POEM), aiming to
alleviate symptoms while considering the risk of
reflux.11 We present a case involving a young patient
initially misdiagnosed and treated for acid peptic disorder (APD), which
was later diagnosed with achalasia cardia following comprehensive
evaluation. Subsequent pneumatic dilation resulted in the alleviation of
her symptoms. Due to its rarity, achalasia often presents a challenge
for early diagnosis, leading to delayed recognition and commonly
mistaken symptoms for other upper digestive issues such as
gastroesophageal reflux .