Achalasia cardia is a primary esophageal motility disorder caused by degeneration of nerves in the esophagus. It is characterized by failure of the lower esophageal sphincter to relax and dilatation of the lower two-thirds of the esophagus. The main symptom is retrosternal or epigastric fullness after meals. Diagnosis involves barium swallow x-ray showing dilated esophagus and manometry showing high lower esophageal sphincter pressure. Treatment options include medications to relax the sphincter, balloon dilatation, botulinum toxin injections, or modified Heller's surgery to cut the sphincter.

1. Achalasia Cardia
synonym : Cardiospasm
Lavina Belayutham

2. Definition
1.‘Achalasia’ is a Greek term that means "does
not relax’.
2. It is a primary oesophageal motility disorder
associated with the spasm of the lower
oesophageal sphincter due to neuromuscular
incoordination characterised by:
a) spasm of the cardiac end of the oesophagus
b) dilatation of the lower two thirds of the
oesophagus

4. Etiology
Hurst :
Degeneration of the Auerback’s plexus leading to failure
of relaxation of the cardiac orifice.
Jackson :
Abnormal pinch-cock action by the right crus of the
diaphragm.
-Aerophagia may be one cause of the dilated oesophagus.
-Principal lesion is the denervation of the oesophageal
smooth muscles.
-Trypanosoma cruzi of the myenteric plexus may be
associated with megaoesophagus ( Chaga’s disease)

5. Symptoms
1. Affects both male and female
2. Insidious in onset
3. Retrosternal or epigastric fullness following
meals is the main symptom
4. Dysphagia is a late symptom( more to liquids
than solids)
5. Regurgitation of swallowed food (especially
at night)
6. Loss of weight

6. Signs
- Pooling of saliva may be seen on indirect
laryngoscopy and may be associated with
reflux laryngitis.

7. Diagnosis
1. Radiography (barium swallow)
- Fusiform dilatation of the oesophagus with
fluid level
- ‘Pencil-tip’ or ‘bird’s beak’ smooth filling
defect of the cardiac end of oesophagus
- Hurst phenomenon : Barium gets into the
stomach like snow flakes.
- Loss of fundal gas shadow.

9. 2. Manometric studies
- low pressure at the body of the oesophagus
and high pressure at the lower sphincter with
failure of the sphincter to relax
3. Endoscopy
- To exclude benign strictures or development
of carcinoma

10. Treatment
1.Medical :
- Smooth muscle relaxants like isosorbide
dinitrite,and calcium channel blockers like
diltiazem,nifedipine and verapamil have been
tried.

11. 2.Surgical:
-Modified Heller’s operation (myotomy of the
narrowed lower portion of the oesophagus )
-Balloon dilatation or dilatation with hydrostatic
bag or ‘Hurst-mercury’ boogies/
-Botulinum toxin type A injection (to relax the
lower oesophageal sphincter)
-Anastomosis between the stomach and
oesophagus may be necessary if the
oesophagus is grossly lengthened or kinked.