Esophageal-cardia dysphagia, also known as cardia spasm and megaesophagus, is a disease caused by neuromuscular dysfunction and is characterized by a lack of peristalsis, high pressure in the lower esophageal sphincter (LES) and a reduced relaxation response to swallowing movements. The disease is a rare disease (estimated to be only about 1 per 100,000 people) and can occur at any age, rarely in children, with approximately equal incidence in men and women, more often in young adults, most often in the 20-39 age group. The main pathological change is the reduction or even disappearance of the number of ganglion cells in the interstitial plexus of the esophageal wall, which can involve the entire thoracic segment of the esophagus, with the most pronounced in the lower and middle esophagus. The disease has a potential risk of developing esophageal cancer if not treated in time. The main features are lack of peristalsis, high pressure of the lower esophageal sphincter (LES) and reduced relaxation response to swallowing movements. Clinical manifestations include dysphagia, retrosternal pain, food reflux and cough and lung infection due to inadvertent aspiration of food reflux into the trachea. First, painless dysphagia is the most common and earliest symptom of the disease. The onset of the disease is slow, but it can also be urgent, and it can be mild at first, with a feeling of fullness after meals. Dysphagia is usually intermittent and is often triggered by mood swings, anger, apprehension and shock, or the consumption of irritating foods such as cold and spicy foods. At the beginning of the disease, dysphagia is intermittent, sometimes mild and sometimes severe, but later it becomes persistent. A few patients have more difficulty swallowing liquids than solid foods. In addition, patients may experience pain, which can be dull, burning, pins and needles, cutting pain or cone pain. The pain is mostly in the posterior sternum and upper middle abdomen; it can also be in the back of the chest, the right side of the chest, the right sternal margin, and the left quadrant of the ribs. The pain attacks sometimes resemble angina pectoris and may even be relieved by sublingual nitroglycerin tablets. As the dysphagia gradually worsens and the esophagus above the obstruction dilates further, the pain gradually decreases. As the dysphagia worsens and the esophagus dilates further, a considerable amount of contents may be retained in the esophagus for several hours or days, and then refluxed when the position is changed. The contents of reflux from the esophagus do not have the characteristics of vomit in the stomach because they have not entered the gastric cavity, but they can be mixed with large amounts of mucus and saliva. In cases of complicated esophagitis and esophageal ulcers, the reflux may contain blood. The inability to eat normally often causes the patient to lose weight, and weight loss is associated with dysphagia affecting the intake of food. For dysphagia, although the patient mostly takes the choice of food, slow food, drink more soup and water to wash down the food during or after eating, or straighten the chest and back after eating, forceful deep breathing or discard breath to assist the swallowing action. If the disease is prolonged, there may be weight loss, malnutrition and vitamin deficiency. Even patients may have anemia and occasionally bleeding due to esophagitis. Barium X-ray examination is very meaningful for the diagnosis of this disease. barium swallow examination shows dilated esophagus, weakened esophageal peristalsis, stenosis of the end of the esophagus in the shape of a bird’s beak, and smooth mucosa in the stenosis, which is typical of patients with pancreatic dystrophy. Henderson et al. classified esophageal dilatation into three grades: grade I (mild), with an esophageal diameter of less than 4 cm; grade II (moderate), with a diameter of 4 to 6 cm; grade III (severe), with a diameter of more than 6 cm, or even curved in the form of a curve. diameter greater than 6 cm and even curved in an S-shape. Esophageal kinetic testing is also meaningful for the diagnosis of this disease. Esophageal manometry shows that the pressure in the high-pressure area of the lower esophageal sphincter is often more than twice as high as normal, and the pressure in the lower esophagus and sphincter does not drop during swallowing. The pressure in the lumen of the upper and middle esophagus is also higher than normal. Gastroscopy is also relevant to the diagnosis of this disease. Gastroscopy can rule out organic strictures or tumors. The endoscopic features of pancreatic dystocia are: 1. In most patients, a medium to large amount of accumulated food remains in the esophagus, mostly in a semifluid state covering the wall, and the mucosal edema thickens resulting in loss of normal esophageal mucosal color; 2. The body of the esophagus is dilated and distorted to varying degrees; 3. Passage. It should be noted that sometimes it is easy to overlook the disease when the perceived resistance of the examination body through the cardia is not very obvious. The diagnosis of this disease is not difficult when combined with the patient’s clinical presentation, barium meal examination, endoscopy and esophageal manometry, and sometimes angina pectoris, esophageal neurosis and esophageal cardia tumors can be confused with this disease. It can cause aspiration respiratory infection, esophagitis, esophageal mucosal erosion, ulceration and bleeding, pressure diverticulum, esophageal-tracheal fistula, spontaneous esophageal rupture, and esophageal cancer. The treatment of cardia incontinentia mainly includes conservative medical therapy: for example, oral 1% procaine solution, sublingual nitroglycerin tablets, and the calcium antagonist nifedipine, which has been tried in recent years to relieve symptoms. To prevent food spillage into the respiratory tract during sleep, high pillows or a raised bed head can be used. Endoscopic treatment: In recent years, with the deepening of the concept of minimally invasive and the emergence of new medical techniques and equipment, endoscopic treatment of pancreatic dystrophy has been widely used and many new advances have been made. Traditional endoscopic treatment can mainly include endoscopic balloon dilatation and stent implantation treatment, microscopic injection of botulinum toxin type A, and endoscopic microwave incision and sclerotherapy. In addition, surgical treatment is also available for patients with moderate or severe cases and those who do not respond well to conventional endoscopic treatment. Myotomy of the cardia (Heller procedure) is still the most commonly used procedure. It can be done transthoracically or transabdominally, or thoracoscopically or laparoscopically. The main long-term complication is reflux esophagitis, and thus there are many advocates of additional anti-reflux surgery, such as fundoplication around the end of the esophagus at 360 degrees (Nissen procedure), 270 degrees (Belsey procedure), 180 degrees (Hill procedure) or suturing the fundus to the ventral segment and anterior wall of the esophagus (Dor procedure). In recent years, transoral endoscopic myotomy (POEM) has been used to treat cardia loss with good results. Transoral endoscopic esophageal sphincterotomy (POEM) is a micro-innovative technique of myotomy through tunnel endoscopy without skin incision, through endoscopic circumferential myotomy of the cardia to maximize the restoration of the physiological function of the esophagus and reduce the complications of the procedure, with early postoperative feeding, relief of dysphagia in 95% of patients, and a low incidence of reflux esophagitis. POEM is perhaps the best choice for the treatment of cardia due to its short duration, minimal trauma, exceptionally fast recovery and reliable efficacy.