Achalasia cardia: a review of 100 cases.

Achaiasia cardia is the commonest benign obstructive lesion of the oesophagus in India. We have reviewed 100 cases over a 20-year period. This is the largest series that has been reported from India. Some unusual features were observed. Males were more often affected than females in a ratio of 2.3:1. Children below the age of 10 years are not often affected, but we had 10 subjects in this age group. In our series dysphagia for solids has been the main presenting feature. Barium swallow X-ray studies of the oesophagus were diagnostic. The treatment of choice had been surgical, and a modified Heller's operation has been the chosen procedure. Our preference is for the thoracic approach. Postoperative complications were few. Long-term follow-up of 65 patients over a 19-year period revealed excellent results in 50 patients (76.9%), good results in 10 (15.4%), and fair and poor results in two (3.1%) and three (4.6%) patients respectively. The fair and poor results occurred in patients with recurrence of symptoms or stricture formation due to reflux oesophagitis. The excellent results even on long-term follow-up, we believe are due to the adequate myotomy that was performed.