Achalasia of the cardia is a motor disorder of the esophagus and lower esophageal sphincter with dysphagia as the dominating symptom. The diagnosis is based on esophageal manometry and barium swallow. During work-up dysphagia of other origin should be excluded by endoscopy. Standard treatment of achalasia today is laparoscopic esophagogastromyotomy with partial fundoplication or pneumatic dilatation of the lower esophageal sphincter. POEM (PerOral Endoscopic Myotomy), a new minimally invasive technique, has recently been introduced in Sweden. So far, 45 patients have been treated. POEM is currently being compared with laparoscopic esophagogastromyotomy within a European randomized multicenter study.