Achalasia Cardia, also known as oesophageal achalasia or often referred to simply as achalasia, is a basically a failure of lower esophageal sphincter to relax properly when food is entering from food pipe into stomach. There may be increased tension in lower oesophageal sphincter and decreased peristalsis of oesophagus (peristalsis – movement of gut to push food forward)
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Primary Achalasia – In most cases no cause can be determined and hence are classified as primary type. There is failure of distal esophageal inhibitory neurons.
Secondary Achalasia – Some patients may have underlying condition like cancer of food pipe, Chagas disease (an infectious disease), Triple A syndrome etc.
Dysphagia – Difficulty in swallowing liquids and solids
Regurgitation – Food and liquid coming back to mouth
Chest pain – Pain in upper abdomen or chest
Barium Swallow X-ray – Multiple X-rays are done after giving contrast material to patient to swallow and its passage is checked by doing X-rays a few times. Contrast will not pass normally and food pipe is seen dilated in cases of achalasia cardia.
Esophageal manometry – This test measures the pressure of food pipe. Pressure of lower oesophageal sphincter is seen abnormally high or is seen not to relax in response to swallow as it should normally and pressure in food pipe may be seen low or its peristalsis may be abnormal.
Surgery – Laparoscopic Heller’s Cardiomyotomy is the gold standard treatment for achalasia cardia which is quite safe and gives best long term relief from symptoms. Since it’s done with key hole method, recovery is very fast and relief of symptoms happens very quickly. Muscles of tight sphincter as well as some surrounding muscles are split open to relieve the spasm which allows easy passage of food. Along with that, a fundoplication is added which prevents reflux of acid and food back into food pipe after surgery.
Balloon Dilatation – By doing endoscopy (inserting a flexible scope from mouth) muscle fibers are stretched and slightly torn by forceful inflation of a balloon placed inside the lower esophageal sphincter. There is always a small risk of a perforation during this procedure and many patients may require repeated sittings. The fibrosis resulting from this procedure make laparoscopic surgery later more difficult.
Medicines – Certain drugs may be useful but their action is often short lived and they many a times cause unpleasant side effects in patients limiting their role in achalasia cardia