Skip to main contentAchalasia treatment in Ahmedabad and Gandhinagar · Dr Harsh Shah · Food Pipe Surgeon · Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Achalasia treatment is chosen by the manometry. High-resolution manometry names the subtype — classic, pressurised or spastic — after an endoscopy has first excluded a growth at the valve that can imitate achalasia. For the classic and pressurised subtypes in a fit patient, POEM and laparoscopic Heller myotomy with a partial wrap work equally well, and graded balloon dilation is the non-operative alternative. For the spastic subtype, POEM is preferred because its cut can be extended along the spastic segment. Tablets and botulinum toxin are temporary measures for patients who cannot have a procedure. No treatment restores the food pipe’s squeezing wave; every one of them opens the valve.
Dr. Jivraj Mehta Hospital
Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Food Pipe Surgeon
· Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad
Dr Harsh Shah has 18 years of experience in surgery of the food pipe and stomach, qualified twice over in surgical gastroenterology. At Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad, the whole achalasia ladder sits under one roof — endoscopy, high-resolution manometry, timed barium studies, balloon dilation, POEM and laparoscopic Heller myotomy — so the choice between them is made on the manometry, not on which procedure happens to be available. Choosing the operation is the part of achalasia care that most deserves an unhurried conversation. Google rating 4.94 from 18 reviews at the Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad listing.
Achalasia is a disorder of the food pipe's muscle. The valve at the lower end — the lower oesophageal sphincter — fails to relax when you swallow, and the muscle of the food pipe above it stops squeezing in a co-ordinated wave. Food and water both hold up above the valve. Every treatment works by opening that valve; none of them restores the squeezing wave. Which treatment suits it depends on the manometric subtype — and that is the decision this page is about.
The pattern that should make anyone suspect it: difficulty swallowing both solids and liquids — that is what separates achalasia from a mechanical narrowing, where solids stick first; bringing back undigested, non-sour food, sometimes at night on the pillow; chest pain, more marked in the spastic form; heartburn that does not respond to antacid tablets, often carried for years under the label of “GERD”; and weight loss.
Endoscopy comes first, in every patient, before any motility label is attached. High-resolution manometry then makes the diagnosis and names the subtype. A timed barium swallow measures how well the food pipe empties, and becomes the yardstick against which the result of treatment is judged later. Treatment is never planned without the manometry subtype.
| Order | Test | What it answers |
|---|---|---|
| First | Upper GI endoscopy | Is there a growth or narrowing at the junction with the stomach that could be imitating achalasia? What does the lining look like? Any suspicious area is biopsied, with a contrast CT and endoscopic ultrasound added, before any motility label is used |
| Second | High-resolution manometry | The diagnosis itself: does the valve relax, and is there any squeezing wave? It names the subtype — classic, pressurised or spastic — which steers the choice of treatment |
| Third | Timed barium swallow | How high the column of barium stands after a few minutes — an objective measure of emptying before treatment, and the clearest check after it |
| Alongside | Symptom score, blood tests, nutrition screen | How severe the swallowing difficulty, regurgitation, chest pain and weight loss are; whether nutrition needs rebuilding first; and fitness for anaesthesia if an operation is likely |
| Only if needed | FLIP panometry | An extra measure of the valve when manometry is equivocal or cannot be tolerated — not a routine test |
Where weight loss has been heavy or eating has nearly stopped, a dietitian and a period of nutritional build-up come before definitive treatment, not after it.
A cancer at the junction of the food pipe and the stomach can imitate achalasia closely — on symptoms, on barium and even on manometry. This look-alike is called pseudoachalasia. It is suspected whenever the history is short, the weight loss is rapid and the patient is over fifty, and it is excluded by endoscopy and biopsy, with CT and endoscopic ultrasound where needed, before any treatment for achalasia is offered.
| Finding | Points towards | What happens next |
|---|---|---|
| Long history, both solids and liquids stick, a dilated food pipe that the endoscope passes through easily | Primary achalasia — a benign motility disorder | Manometry, subtype, and the treatment ladder below |
| Short history, rapid weight loss, older age, a junction the endoscope cannot pass, or an abnormal-looking lining | A growth imitating achalasia | Biopsy, contrast CT and endoscopic ultrasound before anything else; if a cancer is confirmed, it is treated on an entirely different pathway |
| Squeezing preserved but the valve does not relax fully | Outflow obstruction rather than achalasia | Confirmed with barium or FLIP, and treated only if the result is conclusive and the symptoms justify it |
The same awareness carries on after treatment. Long-standing achalasia carries a small lifelong risk of a cancer of the lining of the food pipe, whatever treatment was received and however many years have passed. That is why any new or changed difficulty in swallowing, at any time, means an endoscopy rather than an assumption that the old problem has returned.
Achalasia treatment runs from temporary measures to definitive ones. Tablets and botulinum toxin injection relieve symptoms for a while but do not last; graded balloon dilation, POEM and laparoscopic Heller myotomy are the three definitive treatments. A fit patient is not kept on temporary measures indefinitely.
| Rung | What it is | Where it fits |
|---|---|---|
| Tablets | Nitrates or a calcium-channel blocker before meals | Weak and short-lived, limited by low blood pressure — a last resort, or a bridge |
| Botulinum toxin injection | Injected into the valve through an endoscope | For the frail or unfit, or as a trial; the effect wears off over months, and repeated injections scar the plane that a later myotomy needs — so it is avoided in anyone heading for definitive treatment |
| Graded balloon dilation | The valve is stretched with a balloon in stages, over separate sessions — never a single maximal stretch | A non-operative option where repeatability and cost weigh most, or where the patient prefers it; done only where a tear can be imaged and repaired the same day |
| POEM | Per-oral endoscopic myotomy: the muscle is cut from inside, through a tunnel under the lining, with no skin incision | Strongly preferred for the spastic subtype and spastic disorders, because the cut can be made as long as the spastic segment |
| Laparoscopic Heller myotomy with partial fundoplication | The muscle is cut through keyhole surgery from outside, and a partial wrap (Dor or Toupet) is added against reflux | Equivalent to POEM for the classic and pressurised subtypes; the wrap is part of the operation, not an extra |
For the classic and pressurised subtypes in a fit patient, POEM and laparoscopic Heller myotomy with a partial wrap work equally well, and the decision turns on reflux, anatomy and the patient's own priorities. For the spastic subtype, POEM is preferred, because its cut can be tailored to the full length of the spastic segment. After a failed Heller, POEM can use the untouched back wall; after a failed POEM, a repeat POEM or a Heller is possible.
| Situation | Usually favoured | Why |
|---|---|---|
| Classic or pressurised subtype, fit patient | POEM or laparoscopic Heller with a partial wrap — equally effective | Heller carries a built-in anti-reflux wrap; POEM avoids abdominal incisions but has no wrap |
| Spastic subtype, or a spastic disorder that has failed tablets | POEM with a long, tailored myotomy | The cut reaches the spastic segment higher up the food pipe, which a Heller from below cannot |
| Preference for no operation, or cost and repeatability matter most | Graded balloon dilation | Repeat dilations are part of the plan from the start, not a failure |
| Frail or unfit for anaesthesia | Botulinum toxin, with tablets | Relief without an operation, accepting that it will need repeating |
| Hugely dilated, twisted (sigmoid) food pipe | A myotomy first; removal of the food pipe only for a burnt-out organ that does not empty | A team decision, never made in a hurry |
| Symptoms returned after an earlier Heller or POEM | Repeat manometry, barium and endoscopy first; then POEM, dilation or Heller as the findings show | A tight wrap or a reflux narrowing has to be excluded before re-treating |
Reflux deserves its own sentence, because it is the commonest issue after POEM and is often silent. A food pipe that has lost its nerve supply does not report acid reliably, so reflux after POEM is checked with an endoscopy at follow-up, not judged by symptoms alone, and an antacid tablet is often needed long term. Checking, rather than simply prescribing tablets for life, is the standard followed here.
Not every abnormal manometry needs a procedure. Outflow obstruction with preserved squeezing is treated only if it is confirmed by a second test and the symptoms justify it. Spastic disorders start with an acid-suppressing trial and muscle-relaxing tablets. In pregnancy, definitive treatment is deferred. And in a frail patient, botulinum toxin and tablets may be the right long-term answer.
Over-treatment is a real risk here, so an outflow obstruction is never dilated on the strength of a single tracing. In spastic disorders reflux can itself trigger spasm, so acid suppression comes first, then muscle relaxants; POEM is kept for disease that fails them and is confirmed on manometry.
What is not a reason to delay in a fit patient is the hope that tablets will settle classic achalasia. They will not, and every year of a food pipe holding food lets it stretch further.
Laparoscopic Heller myotomy divides the muscle across the valve and onto the top of the stomach through keyhole incisions, then adds a partial wrap; POEM divides the same muscle from inside, through a tunnel under the lining, with clips to close the entry point; balloon dilation stretches the valve in graded steps as a day-care procedure. All three are preceded by a liquid diet for a day or two and a washed-out food pipe.
Laparoscopic Heller myotomy. The muscle is divided along the lower food pipe and on to the stomach, and a partial wrap is stitched in place. An air-leak test is done on the table; a nick in the lining is repaired and covered by the wrap.
POEM. Through an endoscope, a small opening is made in the lining, a tunnel is created underneath it, and the muscle is divided for a length chosen for the subtype — longer for the spastic form. Carbon dioxide is used instead of air, and the opening is closed with clips. Because there is no wrap, reflux follow-up is built in from the first day.
Graded balloon dilation. Progressively larger balloons on separate sessions, as day care; any chest pain, fever or racing pulse afterwards means an immediate contrast study before going home.
The complications every patient hears about before agreeing: bleeding; infection; clots in the legs or lungs; heart and anaesthetic complications; food going into the lungs; a tear in the lining, usually recognised and closed at the time; a leak found later, which is serious and needs urgent treatment; gas tracking into the abdomen or chest during POEM; reflux, including silent reflux after POEM; swallowing difficulty returning over the years; with balloon dilation, a tear in the food pipe that may need an emergency operation and the need for repeat dilations; for Heller, conversion to open surgery; and a risk to life. Dr Harsh Shah goes through each of these personally before consent, with the figures that apply to your subtype, your age and your previous treatment — they are not general numbers and are not quoted on a page.
A patient who had a Heller’s cardiomyotomy for achalasia cardia describes swallowing again after the operation, in the patient’s own words (in Hindi).
Treatment for achalasia is covered by cashless health insurance and by corporate schemes at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad, subject to the policy's terms. What moves an estimate is which procedure is chosen, whether it is day care or needs an admission, the tests already done, and any extra nights. A written estimate is prepared for your own policy rather than a figure being quoted in general.
Pre-authorisation is arranged by the hospital’s insurance desk, with a note from Dr Harsh Shah’s office describing the manometry diagnosis and the planned procedure. Bring policy papers, identification and every report. If you have had botulinum toxin injections before, bring the dates — it matters for planning a myotomy.
★★★★★
★★★★★
“Excellent doctor. I have undergone Surgery for toupet fundoplication with harsh Shah doctor. Sir has given good treatment for early recovery. Treating patients very friendly. — Ravi Bob, Google review”
Real Google reviews from Dr Harsh Shah’s two listings, reproduced exactly as written.
No treatment restores the food pipe's squeezing wave. Every treatment opens the valve so that gravity and the remaining function can empty the food pipe. Most people eat far more comfortably afterwards, but chewing well, drinking with meals and staying upright after eating remain lifelong habits.
For the classic and pressurised subtypes they work equally well, and the choice depends on reflux, any earlier treatment, and your own priorities. For the spastic subtype POEM is preferred, because its cut can be made long enough to cover the spastic segment. The manometry decides much of it.
POEM has no anti-reflux wrap, and a food pipe affected by achalasia does not sense acid reliably, so reflux can be present without symptoms. An endoscopy at follow-up finds it while it can still be treated simply with tablets.
Yes. Repeated injections scar the layer the surgeon works in during a myotomy, which makes the operation more difficult. It does not rule out POEM or Heller, but the dates of previous injections should be brought to the consultation.
Achalasia itself is benign, but long-standing achalasia carries a small lifelong risk of a cancer of the food pipe's lining. That is why any new or changed difficulty in swallowing, at any time, is checked with an endoscopy.
No. It is an endoscopic, day-care procedure in which the valve is stretched in graded steps over separate sessions. Repeat dilation is expected for some patients and is part of the plan, not a failure.
Dr Harsh Shah consults at Dr. Jivraj Mehta Hospital, Vasna, Ahmedabad.
Patients come to Dr Harsh Shah from across Gujarat and from Rajasthan and Madhya Pradesh. The manometry, the procedure and the first review happen here; later symptom reviews can often be done closer to home, with the yearly endoscopy after POEM planned here.
Told it is “acidity” for years, but both food and water now stick? An endoscopy report, a manometry tracing or a barium study can be sent ahead of the appointment so the consultation starts with them already read; the treatment itself is decided at the consultation, after examination. Call +91-63555-64601 · Send the reports ahead on WhatsApp
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