ACHALASIA CARDIA (Cardiospasm) DEFINITION It is failure of relaxation of cardia (oesophago- gastric junction) due to disorganized oesophageal peristalsis, as a result of failure of integration of parasympathetic impulses causing functional obstruction (Achalasia means failure to relax—Greek). ACHALASIA CARDIA (Cardiospasm) DEFINITION It is failure of relaxation of cardia (oesophago- gastric junction) due to disorganized oesophageal peristalsis, as a result of failure of integration of parasympathetic impulses causing functional obstruction (Achalasia means failure to relax—Greek).

1. en love da Homoeopathy
ACHALASIA
CARDIA

2. ACHALASIA
CARDIA

3. ACHALASIA CARDIA
(Cardiospasm)
DEFINITION
• Itis failure of relaxation of
cardia (oesophago-gastric
junction) due to
disorganizedoesophageal
peristalsis, as a result of
failure of integrationof
parasympatheticimpulses
causingfunctional
obstruction
• (Achalasia means failure to
relax—Greek).

4. AETIOLOGY
• Thereis absence or less
numberedganglionsin
myentericplexus.
• Stress.
• VitB1 deficiency.
• Chaga’sdisease.
• It is caused by
Trypanosoma cruzi,
whichis common in
South America called as
sleeping sickness
• Diffuseoesophageal
spasm (Corkscrew
oesophagus).
• idiopathic.
• Thereis degenerationof
Auerbach’s myenteric
plexusalong theentire
lengthof oesophagus
more so inLOS.
• Achalasia cardiais a
precancerous
condition

5. • There is pencil-shaped
narrowingofcardia (O-G
junction)
• withenormous
dilatationof proximal
oesophagus,
• which contains foul
smelling fluid and is
more pronefor
aspiration
pneumonia.
PATHOLOGY
• Thickening of circular
muscle fibres in distal
oesophagus.
↓
Myenteric inflammation
↓
depletion of ganglioncells
↓
neuralfibrosis,
↓
reduced nitric oxide and
VIP(mediators of LES
relaxation).

6. ↓
Absence of peristalsis
↓
raisedLESpressure
↓
failureof relaxationwith
functional obstruction ofOG
junction.
↓
Dilatation of proximal
oesophagus with atony.
CLINICAL FEATURES
• Common in females between
20 and 40 yearsage group.
• Incidence is 6 per 1,00,000
population.
• Chestpainoccurs inearly
stage.
• Achalasiawithdiffuse
oesophagealspasmis called
as ‘vigorousachalasia’.
• Presentswith progressive
dysphagia, which is more for
liquid than to solid food.

7. • Regurgitation and recurrent
pneumoniaarecommon
(60%).
• Walking while eating, chin
thrusting, neck and shoulder
extension, Valsalva
manoeuvre facilitates
emptying offoodfromthe
oesophagus.
• weightloss.
• Heartburn (50%)iscommon.
• Chest pain during meal is
common.
• Malnutrition and general ill
health.
• Lung abscess formation.
• Odynophagiaand
FEATURES
Triad
• Dysphagia
• Regurgitation
• Weightloss

8. Staging/Grading
I: Proximaldilatation <4cm
II:Dilatation between 4–6cm
III:Dilatation >6 cm IV:Sigmoid
dilatation.
INVESTIGATION
• Bariumswallowis
diagnostic
• Pencil-likesmooth narrowing
of loweroesophagus—Bird
beak appearance
• Dilatationof proximal
oesophagus— cucumber
oesophagus
• Absence of fundic gas
bubble
• Sigmoidoesophagusor
megaoesophagus
• ChestX-rayshowspatchesof
pneumonia.

9. • Double mediastinalstripof
dilatedoesophagusis typical
with air fluidlevel in posterior
mediastinumonlateral view
INVESTIGATION
• Oesophageal manometry
showsunrelaxed lower
oesophageal sphincter with
high restingpressure
• Oesophagoscopyis
doneto confirmthe
diagnosis and to rule
out carcinoma
oesophagus
DIFFERENTIAL
DIAGNOSIS
• Carcinoma
oesophagus.
• Stricture
oesophagus.
• Scleroderma
TREATMENT
• Forcibledilatation:
• Plummer’spneumotic
dilatation

10. • Surgery:™
• ModifiedHeller’s
cardiomyotomy with
Toupet’s/ Dor’s
fundoplication– Open
abdominal/thoracic
(rare)approach
• Endoscopicdilatation
• Surgical myotomy
• Laparoscopic
approach—ideal
• Robotic-assisted
laparoscopicapproach
• Negushydrostaticballoon
dilatation Drugs:
• Botulinum
toxin
• Nitroglycerin
• nifedipine

11. REFERENCE
1. SRB's Manual of Surgery
by SriramBhat M
2. A Manual on Clinical
Surgeryby Das
3. A Concise textbookof
Surgeryby Das

12. A
Special Thanks
To A Very
Special Doctor