Cardia achalasia is one of the most common functional esophageal disorders, but it is not common in clinical practice. To understand this disease, we first need to understand an important anatomical structure – the lower esophageal sphincter (LES). The LES is one of the most crucial parts of the sphincter – it is relaxed when swallowing to facilitate the passage of food and tense when not swallowing to prevent vomiting. Once the normal loosening and tightening function of the LES is disturbed, the above-mentioned achalasia of the cardia will occur, and the corresponding symptoms, as I believe you can guess, are difficulty swallowing and vomiting. The cause of cardia failure is not known and may be related to genetics, autoimmunity, and inflammatory response. Because of this, there is no cure for the cause of the disease, and only symptomatic treatment is usually used, most commonly including esophageal balloon dilation and surgical treatment. Pneumatic dilation has been the most effective first-line treatment option for cardia for a long time. The Rigiflex esophageal dilator, which consists of 3cm, 3.5cm and 4cm diameter balloons, is commonly used in clinical practice. During the operation, the balloon is placed at the location of the LES through a guide wire under the endoscope, and then the 3 balloons are used sequentially in the order of smallest to largest diameter, thus achieving the effect of tearing the LES. A barium swallow test is usually added after completion to rule out esophageal perforation, which is the most serious complication of this treatment. The surgical treatment of pancreatic relaxation was first proposed by Heller in 1913, namely Heller’s myotomy. With the development of minimally invasive surgery, the procedure has evolved from the early open-chest surgery to the endoscopic surgery of today. The main point of the procedure, as the name suggests, is to dissect the lower esophagus and the anterior wall of the cardia, i.e., to destroy the LES structures. This approach appears to be a once-and-for-all approach to the cause of the disease, but it gives the patient another esophageal disease, reflex esophagitis, which is the most common long-term complication of this procedure. Therefore, this procedure is often performed in conjunction with an anti-reflux procedure, such as wrapping the fundus around the esophagus 360° (Nissen procedure) or suturing the fundus to the anterior wall of the ventral segment of the esophagus (Dor procedure).