A Case Report and Literature Review of Achalasia Cardia Presenting as Difficult-to-Treat Asthma

Abstract

Background: Achalasia cardia is a rare neurodegenerative disorder characterized by impaired esophageal peristalsis and failure of the lower esophageal sphincter to relax. Patients often present with dysphagia, regurgitation, or chest pain. However, atypical presentations can mimic respiratory disorders, particularly asthma, leading to diagnostic delay and inappropriate treatment.
Case Presentation: We report the case of a 67-year-old male, non-smoker, who presented with recurrent exacerbations of bronchial asthma. Despite being on optimal bronchodilator therapy with both inhaled and oral corticosteroids for an adequate duration, he showed no clinical improvement. On further evaluation, barium contrast studies revealed features suggestive of achalasia cardia. Surgical intervention was advised; however, the patient deferred and was kept on follow-up.
Conclusion: This case highlights achalasia cardia as an uncommon but important differential diagnosis in patients with difficult-to-treat or refractory asthma. Early consideration of esophageal motility disorders in such scenarios may prevent misdiagnosis, unnecessary prolonged asthma treatment, and allow timely targeted therapy.