Achalasia cardia

1. ACHALASIA CARDIA
 Primary oesophageal motility disorder
 Also called as cardiospasm –because of severe
spasm of circular muscles of lower end of
oesophagus.
 The contracted segment doesn’t relax during
swallowing as a result there is dilatation of,
tortuosity and hypertrophy of the oesophagus
above

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

3. Pathophysiology
Myenteric plexus inflammation/damage
Loss of inhibitory ganglionic cells in myentric plexus
Neurotransmitter inhibition is decreased (nitric oxide)
Imbalance of nitric oxide and Ach
ACHALASIA CARDIA

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

5. Dysphagia
Triad of Achalasia cardia
Regurgitation Weight loss
Staging
I. Proximal dilatation <4cm
II. Dilatation b/w 4-7 cm
III. Dilatation >7cm

6. Investigations
 Barium swallow-
• bird beak appearance of lower oesophagus,
• Dilatation of proximal oesophagus
• Absence of fundic gas bubble
• Sigmoid oesophagus
 X-ray chest- retrocardiac air fluid level lateral view
 Plain X-ray abdomen erect-fundic air bubble is absent
due to stasis of fluid in oesophagus
 Oesophagoscopy-dilated sac containing stagnant
food and fluid due to stasis
LES is closed with air insufflation, rosette apperance
 Oesophageal manometry- Aperistalsis in body of
oesophagus
 Ultrasound- detects subepithelial tumor infiltration in
2ndy achalasia due to distal carcinama

7. Rosette
appearance of
LES on
endoscopy
X-ray

8. Treatment
 Heller’s cardiomyotomy- 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 upto aortic arch and distally up to
stomach to 1-2cm below the junction
 Forceful dilatation- using pneumatic balloon under
fluoroscopic control within LOS(300mmhg pressure applied
for 15 sec)
 Injection treatment- inj botulinum toxin is injected in LES
endoscopically ,blocks Ach release
 Drugs- sublingual nifedipine gives short term releif
 Endoscopic myotomy

9. complications
Carcinoma of mid and lower oesophagus due to chronic
irritation

10. THANK YOU
Gitanjali Kumari
110201312