Achalasia Cardia

Achalasia cardia is a rare esophageal motility disorder characterized by the inability of the lower esophageal sphincter (LES) to relax properly during swallowing, combined with a lack of normal peristalsis (wave-like contractions) in the esophagus. This results in difficulty in moving food and liquid from the esophagus into the stomach. Achalasia can lead to symptoms such as dysphagia (difficulty swallowing), regurgitation, chest pain, and weight loss.

Key Features of Achalasia Cardia:

1. Lower Esophageal Sphincter Dysfunction: The LES, a muscular ring that separates the esophagus from the stomach, fails to relax properly when swallowing.

2. Lack of Peristalsis: The coordinated, rhythmic contractions that propel food through the esophagus are absent or significantly reduced.

3. Dysphagia: Difficulty swallowing, often starting with solids and progressing to liquids.

4. Regurgitation: Incomplete emptying of the esophagus may lead to the regurgitation of undigested food.

5. Chest Pain: Some individuals with achalasia may experience chest pain or discomfort, often after eating.

6. Weight Loss: Persistent difficulty swallowing and regurgitation can result in unintentional weight loss.

Causes and Pathophysiology:

The exact cause of achalasia is not well understood, but it is believed to involve damage or degeneration of the nerve cells in the esophagus that control muscle contractions. The LES fails to relax because of reduced signaling from the nerves, leading to a functional obstruction.

Diagnosis:

1. Esophageal Manometry: This test measures the pressure and coordination of muscle contractions in the esophagus, helping to diagnose the lack of peristalsis and failure of the LES to relax.

2. Barium Swallow (Esophagram): A series of X-rays taken after swallowing a contrast material (barium) to visualize the shape and function of the esophagus.

3. Endoscopy: A flexible tube with a camera (endoscope) is passed through the mouth into the esophagus to examine the lining and rule out other conditions.

Treatment:

1. Balloon Dilation (Pneumatic Dilatation): This procedure involves inflating a balloon in the LES to stretch and disrupt the muscle fibers, allowing for improved relaxation.

2. Heller Myotomy: Surgical procedure where the LES muscle is cut to facilitate easier passage of food into the stomach. This can be done via open surgery or minimally invasive laparoscopic techniques.

3. Botulinum Toxin Injection: Botox injections into the LES can temporarily paralyze the muscle, allowing for improved swallowing. However, the effects are temporary, and repeated injections may be necessary.

Prognosis:

Treatment outcomes for achalasia are generally good, but the effectiveness of interventions may vary among individuals. While some may experience long-term relief, others may require repeat procedures or ongoing management of symptoms.

Complications:

If left untreated or inadequately managed, achalasia can lead to complications such as:

• Esophageal dilation (enlargement) and the formation of a "megaesophagus."
• Increased risk of aspiration pneumonia due to regurgitation of food and liquids into the airways.
• Barrett's esophagus, a condition where the lining of the esophagus changes, increasing the risk of esophageal cancer.

Achalasia cardia is a chronic condition that requires long-term management and follow-up care. Individuals with symptoms suggestive of achalasia should seek evaluation by a healthcare professional for accurate diagnosis and appropriate treatment.

Category : Achalasia Cardia