Achalasia cardia (Cardio spasm) a chronic disease of the neuromuscular system of the esophagus, characterized by impaired opening of the lower esophageal sphincter at the entrance to the stomach during swallowing. This is accompanied by decrease peristaltic movements of the esophagus leads to difficult passage of food into the stomach.
Causes of Achalasia cardia have not been fully established. It believes that Achalasia cardia arises from the mismatch of neural regulatory mechanisms responsible for the peristaltic movements of the esophagus and the relaxation of the lower sphincter in response to food.
The classic triad of presenting symptoms consists of dysphasia, regurgitation, and weight loss. However, heartburn, postprandial choking, and nocturnal coughing are associated common problems. Eating of solid is difficult and laborious and patient need water to gulp the food. With disease progression regurgitation of undigested, foul-smelling foods is not an uncommon phenomenon.
Diagnosis of Achalasia cardia can be obtained by Contrast study, Upper GI Scopy and Manometery. On radiographs show a level of fluid in the enlarged esophagus, changes in the lungs. With the help of a contrast study (barium passage) – note the delay of contrast medium in the esophagus, With esophagogastroscopy make inspection of the walls of the esophagus and esophageal cancer, and exclude other diseases. Manometery is the gold standard for the diagnosis as well as for prognostication.
Endoscopic balloon dilatation (expansion) of the lower openings of the esophagus (the cardia) is usually considered as initial treatment. However effect of dilation lasts only for few months and patients need repeated dilation. The most effective modality is laparoscopic (keyhole) Heller’s myotomy which has most sustainable results. In few very advance cases removal of the esophagus (esophagectomy) may be needed.