Achalasia Cardia

Achalasia cardia is a serious disorder of the esophagus (gullet). Esophagus is a tube that carries food from the mouth to the stomach.

When swallowing food it causes an involuntary wave like motion in the esophagus. This is called peristalsis. Peristalsis pushes food along the esophagus. Just above the entrance to the stomach, close to the heart, there is the lower esophageal sphincter (LES). Normally, with peristalsis, the LES relaxes to allow food to pass from the esophagus to stomach. At times, due to damage to nerves in the esophagus or the LES itself, food stays back in the esophagus. Hence one finds it difficult to swallow.

Abnormal lower esophageal sphincter in achalasia cardia

Causes of achalasia cardia

The following may be the reasons for sphincter to remain closed.

Nerve Dysfunction

The nerve cells is responsible for the peristalsis. Sometimes the nerve cells of the esophagus are affected due to unknown reasons.  The LES is not able to relax due to this and remains contracted . This leads to achalasia cardia.

  • Congenital

    A person can have defective valves right from birth due to genetic abnormalities.

  • Parasitic Infection

    A parasitic infection that affects childhood, called Chagas disease, affect the nerves responsible for peristalsis. Hence LES remains closed causing achalasia cardia. Because food stays back inside the esophagus it leads to development of mega esophagus or enlarged esophagus.

Symptoms of achalasia cardia

The symptoms are mild at first. They worsen over months to years.

  • The main symptom is inability to swallow solids. As the disorder progresses, one might have difficulty in swallowing liquids too.
  • Pain under the breastbone,  especially after meals.
  • Cough when lying down.
  • Heart burn.
  • Weight loss as the disorder progresses.
  • Vomiting food or liquids. In some people this can occur during sleep. The food can get sucked into the airway, leading to problems with respiration (breathing).

Diagnosing Achalasia cardia

Manometry

In this procedure a tube is inserted down the throat to test the pressure in the esophagus and stomach while swallowing. MORE…

Esophagram

Xray is taken of the esophagus while barium is swallowed. Barium is a thick liquid that lights up on x-rays. MORE…

Upper GI Endoscopy

A fiberoptic tube is inserted down the throat and the esophagus is viewed directly through the tube to look for the cause of symptoms. MORE…

Treatments for Achalasia Cardia

Medical Treatments

Medications only provide temporary relief for the swallowing abnormality. The commonly used medications are nitrates and calcium channel blockers. They help by relaxing the muscle controlling opening of the LES. The LES opens and food is emptied into the stomach. This thereby lowers pressure around the LES.

These are small pills that should be placed under the tongue and are usually taken 30 minutes before meal.  They are considered the safest option for achlasia patients providing short term relief.

Endoscopic Treatment

This is an effective procedure for relieving swallowing difficulty (dysphagia) in patients with achalasia. The physician passes a guide wire down the esophagus using an endoscope. With Xray guidance, he positions it inside the LES. A deflated balloon is then advanced along this guide wire. When it reaches the LES, this balloon is inflated for some time. The balloon is again deflated and taken out. This provides symptomatic relief.

Surgical Treatments

If endoscopic procedure is not helpful then a surgery maybe performed, called Heller’s cardiomyotomy.

 

Diet in achalasia cardia

 

  • Eat smaller and more frequent meals. Eat slowly and chew well. Eat moist food.
  • Avoid eating too late.
  • Don’t eat when stressed.
  • Don’t drink during bedtime.
  • Starting your day with a yogurt smoothie and honey might help you to ease your symptoms.
  • Always drink water between the gulps of a meal.
  • Avoid fatty meal and large lumps of meat.
  • Dried chicken can be problematic. So avoid it.
  • Keep atleast two pillows to get propped up at night.

LIMA Experience

Conference to 200+ doctors on Single incision Multiport Appendectomy: Dec, 2013 at Ahmedabad.

Achalasia Specialists

Dr. J. S. Rajkumar

CHIEF SURGEON

M.S., F.I.C.S., Dip. N.B. (SURG.), F.R.C.S. (ENG.), F.R.C.S. (EDIN.), F.R.C.S. (GLASGOW), F.R.C.S. (IRELAND), F.I.M.S., F.A.I.S., F.R.M.S. (LONDON), F.A.E. (GASTRO), F.A.C.G. (USA), F.I.C.A. (USA), F.I.A.G.E.S., Dip M.I.S. (FR.)


Dr. Prabhakaran Raju

Consultant Surgical Gastroenterolgy M.B.B.S., M.S (GENERAL SURGERY), Mch(SGE)

Dr. Anirudh Rajkumar

Bariatric and Laparoscopic Surgeon M.B.B.S., Dip.N.B. (GENERAL SURGERY).