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Fundamentals of Achalasia Cardia
About ‘Achalasia Cardia’
To help you understand the basics, we will start off, with what your esophagus actually does. Esophagus is a narrow tube that starts from your throat and helps carry the food consumed via the mouth, to the stomach. Achalasia is a serious condition that affects your esophagus. At the lower end of esophagus is the lower esophageal sphincter (LES), a valve that opens everytime you swallow and lets the food from lower end of esophagus to enter the stomach and closes off once the food is in the stomach. In patients diagnosed with an Achalasia Cardia, what happens is, this LES fails to open up, while you eat your food. And this can invariably lead to a serious damage, in the sense, there is difficulty in swallowing and accumulation of food, within your esophagus. This particular condition is generally attributed to two major reasons.
- On account of damaged nerves, in your lower esophagus and
- Dysfunction of the LES
The above explanation clearly defines the meaning of the disorder namely ‘Achalasia Cardia’.
Causes for Achalasia Cardia
There are several reasons as to why people are diagnosed with the esophageal malfunction. These are
- Autoimmune - where the body’s immune system can erroneously affect healthier cells, present within the esophagus
- Infection – either a viral infection (measles, varicella) or parasitic (Trypanosoma cruzi) have been implicated as possible factors.
- Cancer at the lower end of esophagus.
Symptoms of Achalasia
The symptoms associated with Achalasia Cardia are as follows
- Difficulty in swallowing experienced at the chest level
- Chest pain
- Heart burn
- Weight loss
- Cough or choking of food due to spill over of food accumulated in the esophagus.
Diagnosis of an Achalasia Cardia
Physical examination and laboratory tests do not provide any clue about the disease
- Esophageal Manometry- In this procedure, a tube is placed in your esophagus and the muscle activity of the esophagus and lower esophageal sphincter are recorded while you swallow a test liquid or solid. The resultant graph will depict the functional problems of the esophagus and the sphincter
- Barium X-Ray – You will be asked to drink a chalky solution containing Barium and X rays are taken while you drink the solution
- Endoscopy- Endoscopy again is inserting a thin tube, with a camera fitted at the rear end. The endoscope visualizes the non relaxation of the sphincter and the damage caused by the accumulation of food within the esophagus.
Your doctor prescribes oral medications as the first line of treatment. These include
- Nitrates or calcium channel blockers to relax the sphincter, allowing food to pass through the LES, more easily.
- Botox injections can relax the sphincter but the effect is short lasting.
- Dilation of the sphincter- This can be a permanent solution to treat Achalasia. What the doctor does is, he inserts an endoscope and a balloon is inflated at the lower esophageal sphincter. This stretches out the sphincter and can help the LES function in a better way. Dilation rarely can perforate the esophagus and in this situation you may need an additional surgery to repair it.
- Esophagomyotomy is a surgical option for you to get rid of the esophageal disorder. Your doctor uses a large incision across the sphincter to carefully alter the function, so that food now passes easily into the stomach .
Esophagomyotomy was traditionally performed through the open surgical approach.Laparoscopic esophagomyotomy is the gold standard with short hsopitalisation, recovery time and excellent outcomes.