Excel Hospital
  • What is Achalsia Cardia?

    • Achalasia Cardia is a primary oesophageal motility disorder, characterised by a hypertensive lower oesophageal sphincter (LOS) which fails to relax on swallowing, and by aperistalsis of the body of the oesophagus.
    • Incidence of achalasia is 1 to 2 per 200,000.

  • Causes

    • Unknown
    • Infection - viral
    • Genetic influence

  • Symptoms

    • Difficulty in Swallowing - the most common presenting symptom (It generally concerns both liquids and solids from the outset)
    • Regurgitation of undigested food during or shortly after a meal
    • Sub/retrosternal pain
    • Heartburn
    • Weight loss
    • Nocturnal coughing

  • Daignosis

    • Barium Swallow
    • Esophageal Manometry
    • Upper GI Endoscopy

  • Treatment

    Surgery (preferably Laparoscopy) – helps 90% of Achalasia patients.
    • Cardiomyotomy + Fundoplication (SOS).
    • Myotomy cuts only through the outside muscle layers which are squeezing leaving the inner muscosal layer intact ( "wrap" is generally added in order to prevent excessive reflux, which can cause serious damage to the esophagus over time).

    Endoscopy – balloon (pneumatic) dilation ( generally in elderly patient with high risk ).
    Here the muscle fibers are stretched and slightly torn by forceful inflation of a balloon placed inside the lower esophageal sphincter. There is always a small risk of a perforation which requires immediate surgical repair.
    • Pneumatic dilatation causes some scarring which may increase the difficulty during surgery if the surgery is needed later.
    • Gastroesophageal reflux (GERD) occurs after pneumatic dilatation in some patients.
    • The benefits tend to be shorter-lived in younger patients. It may need to be repeated with larger balloons for maximum effectiveness.
    • Since 2010, a new endoscopic treatment modality has been introduced- POEM (peroral endoscopic myotomy).

    Medication – for patients who have failed with other treatment options.
    Drugs that reduce LES pressure are useful
    Calcium channel blockers ( nifedipine)
    2) Nitrates ( isosorbide dinitrate , nitroglycerin )
    However, many patients experience unpleasant side effects such as headache and swollen feet, and these drugs often stop helping after several months.
    3) Botulinum toxin (Botox) may be injected into the lower esophageal sphincter to paralyze the muscles holding it shut.The effect is only temporary and lasts about 6 months. Botox injections cause scarring in the sphincter which may increase the difficulty of later myotomy. This therapy is recommended only for patients who cannot risk surgery, such as elderly persons in poor health.

  • Follow Up

    • Even after successful treatment of achalasia, swallowing may still deteriorate over time. The esophagus should be checked every year or two with a timed barium swallow because some may need pneumatic dilatations, a repeat myotomy, or even esophagectomy after many years.
    • In addition, some physicians recommend pH testing and endoscopy to check for reflux damage, which may lead to a premalignant condition known as Barrett's esophagus or a stricture if untreated.