Achalasia cardia is a rare disorder of esophagus. There are many incidences where it is misdiagnosed because of its rarity of occurrence.
Achalasia cardia is a primary motility disorder of the esophagus. It is also known by various names such as cardio spasm, esophageal achalasia etc.
The esophagus is made up of smooth muscles, and is mainly responsible to transport food and liquid from the mouth to the stomach. The relaxation and contraction of these muscles makes the food to slide down into the stomach. However in achalasia cardia there is total absence of peristalsis of esophagus, and failure of the lower esophageal sphincter to relax when food or liquid is swallowed.This gives rise to vomiting of food or liquid as soon as it is swallowed.
Causes Of Achalasia Cardia
The exact cause of Achalasia cardia remains unknown. Postulated theories for this disorder are:
- Disturbance in the vagus nerve
- Persons, who have the habit of breathing from mouth.
- Genetic predisposition.
Achalasia Cardia Symptoms
Symptoms of achalasia cardia may vary, depending on the time when the diagnosis is made.
- Initially the patient may feel mild sensation of food sticking in the mid epigastric area.
- Gradual difficulty in swallowing fluid is noted more than for solids.
- The patient may use specific maneuvers for emptying of food from the esophagus.
- As swallowing becomes more difficult regurgitation of food and fluid may occur.
- Regurgitation occurs soon after eating or at night
- Pain in the chest.
- Weight loss.
- Violent coughing.
- Respiratory complication of aspiration pneumonia.
Esophageal Achalasia Treatment
There are three modalities of treatment for achalasia cardia
- Pneumatic dilatation of esophagus: it is the common form of treatment; it is non operative quick and simple procedure. The aim is to dilate the esophageal spincter and esophagus, with a balloon like dilator. It is successful in most of the experienced hands.
- Surgical correction of the esophageal muscles: surgery is resorted, if the above non invasive dilatation method fails.
- Drugs such as smooth muscle relaxant: drugs which relax lower esophageal sphincter such as calcium channel blockers are used. Short term improvement is seen, but long term efficacy is doubtful. Therefore drugs are used only to buy time till the patient is readied for surgery.