Achalasia Cardia

1. Achalasia Cardia
Name- Avtansh Gupta
Group- 501

2. Achalasia Cardia is a rare
disorder that makes it
difficult for food and
liquid to pass from the
swallowing tube
connecting your mouth
and stomach (esophagus)
into your stomach.
Achalasia Cardia occurs
when nerves in the
esophagus become
damaged.
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Why your esophageal muscles fail to contract and relax normally is unknown. One theory is
that achalasia is an autoimmune disease (your body attacks itself) that is triggered by a virus.
Your immune system attacks the nerve cells in the muscle layers of the walls of your
esophagus and at the LES. Your nerve cells, which control muscle function, slowly degenerate
for reasons that are not currently understood. This results in excessive contractions in the
LES. If you have achalasia, the LES fails to relax and food and liquids can’t pass through your
esophagus into your stomach.
Etiology

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▪ q Idiopathic- it occurs due to absence/degeneration of Auerbach’s plexus throughout
the body of oesophagus, causing improper integration of parasympathetic impulse
▪ q Acquired variety- in America, caused by Trypanosoma cruzi which destroys ganglion
cells of Auerbach’s plexus.(Chagas disease)
▪ q Stress
▪ q Emotional factors
▪ q Vitamin B1 deficiencies

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Achalasia is a heterogeneous
disease categorized into 3 distinct
types based on manometric patterns:
• type I (classic) with minimal
contractility in the esophageal
body,
• type II with intermittent periods of
panesophageal pressurization,
and
• type III (spastic) with premature or
spastic distal esophageal
contractions
Classification

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Achalasia symptoms generally appear gradually and worsen over time. Signs and symptoms may
include:
• Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat
• Regurgitating food or saliva
• Heartburn
• Belching
• Chest pain that comes and goes
• Coughing at night
• Pneumonia (from aspiration of food into the lungs)
• Weight loss
• Vomiting
Signs And Symptoms

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• qWomen around 20-40 yrs. of age are commonly affected
• q Female : male:: 3:2
• q Progressive Dysphagia-which is more for liquids than solid food.
• q Regurgitation and recurrent pneumonia are common
• q Malnutrition and ill health
• q Retrosternal discomfort - pain also radiates to intrascapular region
• q Odynophagia and weight loss
Clinical Picture

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q Barium swallow-
• Bird beak appearance of lower oesophagus,
• Dilatation of proximal oesophagus
• Absence of fundic gas bubble
• Sigmoid oesophagus
q X-ray chest- retrocardiac air fluid level lateral view
q Plain X-ray abdomen erect-fundic air bubble is absent due to stasis of fluid in oesophagus
q Oesophagoscope - dilated sac containing stagnant food and fluid due to stasis LES is closed
with air insufflation, rosette appearance
q Oesophageal manometry- A peristalsis in body of oesophagus
q Ultrasound- detects subepithelial tumour infiltration in 2ndy achalasia due to distal carcinoma
Diagnosis

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13. Treatment
Medication: Gastroenterologist might
suggest muscle relaxant before eating.
medication treatments include nifedipine
(Procardia XL®, Adalat CC®) or
isosorbide (Imdur®, Monoket®). These
medications relax the spastic oesophageal
muscles by lowering LES pressure. These
treatments are less effective than surgery
or balloon dilation and provide only short-
term relief of your symptoms.
Balloon dilation
In this non-surgical procedure, you’ll be put under light
sedation while a specifically designed balloon is inserted
through the LES and then inflated. The procedure relaxes
the muscle sphincter, which allows food to enter your
stomach. Balloon dilation is usually the first treatment option
in people in whom surgery fails.
You may have to undergo several dilation treatments to
relieve your symptoms, and every few years to maintain
relief.
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Esophagectomy
Removal of your oesophagus is a last resort treatment.

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15. Treatment
q Heller’s cardio myotomy- surgical 7-10cm long incision made through lower oesophageal end
and carried over to stomach ,muscles are cut till mucosa bulges out. Myotomy should be extended up
to aortic arch and distally up to stomach to 1-2cm below the junction
q Forceful dilatation- using pneumatic balloon under fluoroscopic control within LOS(300mmhg
pressure applied for 15 sec)
q Injection treatment- inj botulinum toxin is injected in LES endoscopically ,blocks Ach release
q Drugs- sublingual nifedipine gives short term relief
q Endoscopic myotomy
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Management

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Thank You