Other names of Achalasia cardia are oesophagal achalasia, cardiospasm and oesophagal aperistalsis.
Achalasia cardia is a motility or movement disorder of smooth muscles of lower oesophagal Sphincter characterized by an inability to dilate or to open when needed. Its main features are incomplete relaxation, absence oesophageal movement (peristalsis), increase lower oesophagal sphincter tone and production of functional stenosis or functional stricture. The cause of achalasia cardia is uncertain.
Signs and symptoms of Achalasia Cardia
- Difficulty in swallowing (Dysphagia) is the main symptom of achalasia cardia, Solid (dry) food effect more than soft or liquids food.
- Regurgitation of undigested food, the patient often induces vomiting to relieve pain.
- Chest pain usually retrosternal and sometimes mistakes with the heart attack.
- Weight loss.
- People may experience a cough at lying position or during sleep.
Diagnosis of Achalasia cardia:
Lots of conditions present with similar symptoms. To rule out other disease investigation is mandatory, among these-
- X-Ray chest P/A View:
Shows vast dilatation of oesophagus with an absence of gastric air babble or little gastric air
- Barium swallow X-Ray:
Barium is a contrast media. The patient swallows it with continues X-Ray recording to follow the movement of barium. Huge dilatation of oesophagus with a slow passage of barium into stomach gives the appearance of “Bird’s beak or Rat’s tail” at the lower end of the oesophagus.
- Oesophagal manometry:
it the gold standard for diagnosis, it measures muscle contraction at the different level of the oesophagus and in case of Achalasia cardia manometry identifies the failure of the lower oesophagal sphincter to relax during swallowing and absence of peristalsis of the smooth muscle of the oesophagus.
The endoscopy of the oesophagus to rule out Ca-esophagus.
Lower oesophagal pH monitoring to rule out gastroesophageal reflux disease.
Some tissue is done to identify myenteric plexus.
Other conditions may present like Achalasia Cardia
- Oesophagal carcinoma
- Oesophagal stricture
- Gastro-oesophageal reflux disease
- Plummer Vinson syndrome
- Rozycki syndrome
- Chagas disease.
Management of achalasia cardia
- Calcium channel blockers (sublingual, nifedipine) and nitrates improve mild to moderate achalasia cardia.
- Heller myotomy is the most effective treatment.
- Pneumatic dilatation of lower oesophagal sphincter is a good option for the patient who is not fit for Heller myotomy.
- Botulinum toxin injection also an effective option for the unfit patient but its recurrence within 12 months is very high.
- Lifestyle modification always a good option for every disease. Slow eating, plenty of water during meals, Chew well, avoid bedtime eating and raising head during sleep improve the condition whereas caffeine-containing food should be avoided.