Cardia achalasia is something that many people have never heard of because it is rare and its annual incidence is only 1 in 100,000. But China has a population of 1.3 billion, and there will be 13,000 new cases each year, which is not a small number. This group is a cause for concern. Cardia insipidus can occur in infants just a few days old or in the elderly. The main symptoms of patients are dysphagia, regurgitation and vomiting. This is especially true in adults because the patient’s esophageal peristalsis is very poor and it is surprisingly painful for them to try to swallow food from the inside of their mouth to the esophagus and then into the stomach. Food is retained in the lumen of the esophagus in large quantities due to the tight closure of the cardia, and when the amount of food accumulates to a certain level, it refluxes from the esophagus to the mouth, causing vomiting. As a result, the patient’s eating speed becomes very slow, and the patient has to drink a lot of water to swallow the slightest solid food. Eventually, they will also become extremely thin due to malnutrition, which will affect their work and normal life. It’s a pity that because it’s a rare disease, doctors rarely see it in county and city hospitals, so many patients are not diagnosed in time, and only after years of illness do they come to our clinic to be diagnosed. This disease is currently treatable, but if left untreated for a long time, the chance of complicating esophageal cancer will increase greatly. Moreover, early treatment is more effective than late treatment. The diagnosis of achalasia relies on symptoms, barium esophagus meal, gastroscopy and esophageal manometry. An experienced gastroenterologist can basically determine if it is this disease by a simple questioning. I will mention here a few points on which the doctor bases his judgment, and also provide some reference for patients and friends who suspect this disease. The performance of patients with achalasia generally has the following points: 1. The first time dysphagia occurs most of them have obvious triggers, such as after an argument with someone, after seeing the scene of a car accident, after the death of a loved one, etc. There are also chronic and continuous psychological stress such as many patients are senior students or children of single-parent families. 2. The symptoms of dysphagia occur intermittently at first, good days, bad days, good times like normal people, bad times when it is difficult to drink water. 3. Although the patient’s symptoms are obvious, the first gastroscopy at the local hospital is usually normal or chronic gastritis, because many doctors do not recognize this disease. If there are symptoms of dysphagia and more than two of the above criteria are met, this disease should be highly suspected. Cardia incontinentia is treatable and can be treated very well. The main treatment options are botulinum toxin injections, balloon dilation, surgery and transoral endoscopic myotomy (POEM). Botox injections are very safe, but have a very high recurrence rate and are not generally the treatment of choice. Balloon dilation is more than 75% effective at 5 years, but there is a higher incidence of a serious complication called perforation, up to 3%. Surgical procedures have the best long-term outcome, but can be more invasive than balloon dilation. The results of the latest studies are controversial as to which is best, balloon dilatation or surgery, with some believing that two consecutive balloon dilatations are as effective as surgery, and others believing that surgery is better. In fact, the long-term efficacy of both approaches is clearly able to resolve the patient’s dysphagia, it is just not clear who is better. POEM is a minimally invasive procedure for the treatment of achalasia of the cardia that was born only in 2010 and is done through gastroscopy, with no incision on the skin surface and can achieve a degree of myotomy comparable to that of surgery. Thousands of patients have already undergone this treatment in China and the results are now seen to be superior to balloon dilation. Although POEM is theoretically less invasive than surgery, there is no clear evidence of evidence-based medicine as to whether it is in fact superior to surgery. I hope that those who read this article will remember one thing: cardia can be treated very well, so don’t give up hope and stop living in the pain of “eating” that people can’t understand! Say it out loud, pancreatic achalasia, goodbye!