Cardia achalasia is not uncommon in clinical practice and is most often seen in young adults. The clinical manifestations are dysphagia, food reflux and lower retrosternal discomfort or pain. Clinical manifestations: 1, dysphagia: the onset of the disease is more slow, but can also be more urgent, the initial can be mild, only after the meal with a feeling of fullness. Dysphagia is mostly intermittent, often triggered by mood swings, anger, apprehension, shock or eating too cold and spicy food and other irritants. 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 in swallowing liquid than solid food, but most patients have more difficulty in swallowing solid than liquid, or swallowing solid and liquid food with equal difficulty. 2, pain: the nature varies, it can be boring, burning pain, pinprick pain, cutting pain or cone pain. The pain site is mostly in the posterior sternum and middle and upper abdomen; it can also be in the back of the chest, the right side of the chest, the right sternal margin and the left quarter rib area. The pain attacks sometimes resemble angina pectoris and may even be relieved by sublingual nitroglycerin tablets. With the gradual increase of dysphagia and further dilatation of the esophagus above the obstruction, the pain can be gradually reduced. Food reflux: With the aggravation of dysphagia and further dilatation of the esophagus, a considerable amount of contents can be retained in the esophagus for several hours or days and reflux out 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 the case of complications of esophagitis and esophageal ulcer, the reflux may contain blood. 4.Weight loss: Weight loss is related to the difficulty in swallowing affecting the intake of food. 5. Bleeding and anemia: Patients may often have anemia and occasionally bleeding due to esophagitis. 6. Other symptoms: Due to the increased tone of the lower esophageal sphincter, erratic reflux rarely occurs in patients, which is an important feature of the disease. In late cases, the aspiration of regurgitated material from the esophagus into the airway produces coughing, shortness of breath, wheezing and hoarseness. Auxiliary examinations: 1. Barium meal X-ray examination of the esophagus shows that the barium is retained in the cardia, and the lower part of the esophagus shows a bird’s mouth narrowing with smooth edges, and the barium enters the stomach slowly in a thin stream. The lumen of the middle and lower esophagus is enlarged, and in severe cases, the lumen of the esophagus is highly thickened, extended and tortuous in the shape of “S”, like the sigmoid colon. The normal peristalsis of the esophageal wall is weakened or disappeared, and sometimes there is a weak contraction of the regulations. Gastroscopy shows enlarged esophageal lumen with food retention and mucosal edema and inflammation. 3.Esophageal pressure measurement: the pressure in the lower high-pressure area 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 middle and upper esophageal lumen is also higher than normal, and the normal esophageal peristaltic wave does not appear when swallowing. Subcutaneous injection of acetylcholine chloride 5-10mg can enhance esophageal contraction in some cases, significantly increase the pressure in the middle and upper esophageal lumen, and can cause severe pain behind the sternum. Treatment: 1. Pharmacotherapy: Patients with early pancreatic spasm should explain their condition, stabilize their emotions, eat less and more, chew and swallow slowly, and take sedative and antispasmodic drugs, such as calcium antagonist nifedipine, which can relieve symptoms. To prevent food overflow into the respiratory tract during sleep, use high pillows or padding the head of the bed. 2.Dilatation of lower esophagus After placing the apical capsule catheter in the cardia, inject water, barium or mercury into the capsule to make the capsule expand, and then pull it out strongly to break the muscle fibers to enlarge the lumen of the narrowed lower esophagus, which is effective in about 2/3 patients, but repeat dilatation is needed. In a few patients, there is a risk of complicating esophageal perforation. At present, lower esophageal dilatation is only suitable for early cases where surgery is contraindicated or refused and the esophagus is not yet highly enlarged. 3.Surgical treatment: Traditional surgery is usually performed through the chest, with long incisions and trauma, causing a lot of pain to the patient. Nowadays, the surgery can be done under thoracoscopy or laparoscopy, and only three small incisions of about 1-1.5 cm are needed on the chest wall or abdominal wall. The main points of the operation: the muscle layer of the esophageal wall is incised longitudinally on the left side of the anterior exterior of the esophageal wall, reaching deep into the mucosa, but without cutting through the mucosal layer. The lower end of the incision crosses the gastroesophageal junction, and the muscle layer of the gastric wall only needs to be cut for 1 cm; the upper end of the incision should be extended to the top of the enlarged hypertrophic segment of the esophageal wall, and the length of the incision varies depending on the lesion, and is generally about 5-10 cm long. after all the longitudinal and circular muscle fibers of the esophageal wall are cut, the muscle fibers are carefully freed between the muscle layer and the mucosa, and their width is about half of the circumference of the esophagus to prevent scar formation between the cut ends of the posterior muscle fibers. After freeing the muscle fibers, the mucosa will be expanded from the muscle layer incision. The procedure is simple, less invasive, effective, and has very few complications. 90-95% of cases have improved symptoms after surgery, and the complication rate of reflux esophagitis is only 2%.