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 .