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Achalasia Cardia?

What is Achalasia Cardia?

Achalasia cardia is the failure of LES (lower esophageal sphincter) to relax and let the food pass down to stomach leading to difficulty in swallowing food.

If you have achalasia, your LES fails to open up during swallowing, which it’s supposed to do. This leads to a backup of food within your esophagus. This condition can be related to damaged nerves in your esophagus. It can also be due to damage of the LES.

Causes of Achalasia Cardia

The main cause of achalasia is degeneration of the nerve cells in the esophagus (the food pipe). The exact reason why this happens is not known. The loss of nerve cells in the esophagus causes two major problems that interfere with swallowing. Firstly, the muscles that line the esophagus do not contract normally, so that swallowed food is not pushed forward through the esophagus and into the stomach properly. Secondly the lower esophageal sphincter (LES), a valve made of of muscles, does not relax with swallowing as it does in normal people. As a result, the esophagus above the persistently contracted LES starts to dilate, and large volumes of food and saliva can accumulate in the dilated esophagus.

Symptoms &

Diagnosis

The symptoms of achalasia include:

  • Difficulty swallowing both solid and liquid food.
  • Regurgitation of food that is retained in the esophagus. If this happens at night, food may be aspirated into the lungs, a serious medical problem.
  • Chest discomfort from esophageal dilation and/or retained food.
  • Sharp chest pain usually of unclear cause.
  • Heartburn
  • Loss of weight due to reduced intake of food

Diagnosis of Achalasia Cardia

The diagnosis can be made based on symptoms and following tests are done to confirm the diagnosis.

  • Barium swallow
  • Endoscopy
  • Manometry

Treatment

Treatments for achalasia include:

  • Lifestyle modifications: such as eating slowly, chewing well, and avoiding food immediately before bedtime, sleeping with head raised and drinking plenty of foods helps in relieving symptoms to some extent.
  • Oral medications: Oral medications that help to relax the lower esophageal sphincter include groups of drugs called nitrates and calcium channel blockers.
  • Injection of botulinum toxin (Botox) into the sphincter: Another treatment for achalasia is the endoscopic injection of botulinum toxin into the lower sphincter to weaken it. Injection is quick, nonsurgical, and requires no hospitalization. Injection is a good option for patients who are very elderly or are at high risk for surgery.
  • Surgery to cut the sphincter (esophagomyotomy): The sphincter also can be cut surgically, a procedure called esophagomyotomy. The surgery can be done using an abdominal incision or laparoscopically through small punctures in the abdomen.

All treatments reduce the pressure within the lower esophageal sphincter (LES) to allow easier passage of food from the esophagus into the stomach. The muscle of the LES is divided leaving the mucosa (inner lining of the esophagus) intact.

Frequently Asked Question

Achlasiaecardia is the failure of the (LES) lower esophageal sphincter to relax and let the food pass down to the stomach which leads to difficulty in swallowing food.

The exact cause is not known, however there is degeneration of the nerves to esophageal muscles.

The complications of achalasia include weight loss and aspiration pneumonia. There often is inflammation of the esophagus, called esophagitis, which is caused by the irritating effect of food and fluids that collect in the esophagus for prolonged periods of time. There may be esophageal ulcerations as well. There is an increased occurrence of cancer of the esophagus in patients with achalasia.

Patients with Achalasia present with difficulty in swallowing, regurgitation and chest pain. It can be diagnosed by Upper Gastrointestinal Endoscopy, barium swallow or manometry.

  • Lifestyle modifications
  • Oral medications
  • Injection of botulinum toxin (Botox)
  • Stretching of the lower esophageal sphincter (dilation)
  • Surgery to cut the sphincter (esophagomyotomy)
  • Less postoperative pain
  • May shorten hospital stay
  • Quicker return to normal activity
  • Less chances of wound infection

The amount of pain is different for each person. The pain can be controlled with the help of pain control medications. You will be able to walk and go to the bathroom yourself.

Generally, you can be discharged 2 days following surgery.

In general, plan to take about one week off from work.

Mostly the procedure is covered under most medical insurance plans. Please confirm in your policy documents.

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