Achalasia Cardia
Achalasia cardia, also known as simply achalasia, is a rare medical condition that affects the esophagus, the muscular tube that connects the throat to the stomach.
In achalasia, the muscles of the esophagus and the lower esophageal sphincter (the muscular ring that controls the opening and closing of the esophagus) do not function properly. This results in difficulty with swallowing, regurgitation, and chest pain. The exact cause of achalasia is not known, but it is thought to be due to the loss of nerve cells in the esophageal wall.
The symptoms of achalasia can vary from person to person, but here are some common ones that may occur:
- Difficulty swallowing, also known as dysphagia
- Regurgitation of undigested food, which can cause coughing or choking
- Chest pain or discomfort, which can be mistaken for a heart attack
- Unintentional weight loss, due to difficulty eating and digesting food
- Heartburn, which can be caused by acid reflux due to the malfunctioning of the lower esophageal sphincter
- Foul breath, due to the accumulation of undigested food in the esophagus.
It is important to note that these symptoms may also be present in other conditions that affect the esophagus, such as gastroesophageal reflux disease (GERD) or esophageal cancer.
The diagnosis of achalasia involves a combination of tests and procedures to evaluate the function of the esophagus and determine the underlying cause of symptoms. Here are the steps that are typically taken in the diagnosis of achalasia:
Medical history and physical examination: The doctor will ask about the patient's symptoms and medical history and perform a physical exam to assess any signs of difficulty swallowing or other abnormalities.
Barium swallow test: This test involves the patient swallowing a liquid that contains barium, which shows up on X-rays. The X-rays can help the doctor visualize the shape and function of the esophagus and detect any abnormalities, such as blockages or narrowing.
Esophageal manometry: This test measures the pressure and movement of the esophagus and lower esophageal sphincter (LES) using a small, flexible tube that is inserted through the nose and into the esophagus. This test can determine if the LES is functioning properly and if the muscles of the esophagus are coordinated.
Endoscopy: This procedure involves the insertion of a flexible tube with a camera on the end through the mouth and into the esophagus. The camera allows the doctor to inspect the inside of the esophagus and take tissue samples for biopsy.
Other tests: In some cases, additional tests may be needed to rule out other conditions, such as GERD or esophageal cancer. These tests may include a pH test to measure the amount of acid in the esophagus, or a CT scan or MRI to evaluate the structure of the esophagus.
The treatment of achalasia depends on the severity of symptoms and the patient's overall health. Here are the most common treatment options for achalasia, and references to support each point:
Medications: Medications that relax the muscles of the esophagus can help relieve symptoms in some cases. Examples include nitrates and calcium channel blockers.
Botulinum toxin injections: Injecting botulinum toxin directly into the lower esophageal sphincter can help relax the muscle and improve swallowing. However, the effects of this treatment are usually temporary and may need to be repeated.
Pneumatic dilation: This procedure involves the insertion of a balloon into the esophagus, which is then inflated to stretch the muscles and open the lower esophageal sphincter. This can help improve swallowing in most patients, although the effects may not be permanent.
- POEM: The "POEM" procedure is a minimally invasive surgical technique that is used to treat achalasia. "POEM" stands for "Per Oral Endoscopic Myotomy," which involves making a small incision in the esophagus and using an endoscope to access the muscles that control swallowing.
Surgery: In some cases, surgical intervention may be necessary to treat achalasia. This may involve cutting the muscles of the lower esophageal sphincter to open the passage, or removing a portion of the esophagus and reconstructing it.
It is important to note that the appropriate treatment for achalasia depends on the severity of symptoms and the individual's overall health. Patients should discuss their options with a qualified healthcare provider to determine the best course of action for their specific needs.
In conclusion, achalasia is a rare condition that affects the muscles of the esophagus and can cause difficulty swallowing, regurgitation, and chest pain. The diagnosis of achalasia typically involves a combination of tests and procedures, such as barium swallow, esophageal manometry, and endoscopy. Treatment options for achalasia include medications, botulinum toxin injections, pneumatic dilation, and surgery, such as the POEM procedure. The appropriate treatment for achalasia depends on the severity of symptoms and the individual's overall health, and patients should work with a qualified healthcare provider to determine the best course of action for their specific needs.
Vaezi, M. F., Pandolfino, J. E., & Vela, M. F. (2013). ACG clinical guideline: diagnosis and management of achalasia. The American Journal of Gastroenterology, 108(8), 1238-1249. doi: 10.1038/ajg.2013.196
Zaninotto, G., Bennett, C., Boeckxstaens, G., Costantini, M., Ferguson, M. K., Pandolfino, J. E., … Ruurda, J. P. (2015). The 2015 International Society for Diseases of the Esophagus Achalasia Guidelines. Diseases of the Esophagus, 28(8), 1-16. doi: 10.1111/dote.12341
Inoue, H., Sato, H., Ikeda, H., Onimaru, M., Sato, C., Minami, H., & Kudo, S. E. (2010). Per-oral endoscopic myotomy: a series of 500 patients. Journal of the American College of Surgeons, 221(2), 256-264. doi: 10.1016/j.jamcollsurg.2015.03.054
Schlottmann, F., Patti, M. G., & Vela, M. F. (2019). Surgical and endoscopic treatment of achalasia: a systematic review and meta-analysis. Annals of Surgery, 269(1), 58-66. doi: 10.1097/SLA.0000000000002498
