Achalasia Cardia – Cardiospasm

Achalasia means ‘failure to relax’. Achalasia Cardia is a condition in which there is failure of oesophageal peristalsis along with the failure of lower oesophageal sphincter.

It is a chronic progressive disorder in which retention of food occurs in the oesophagus and also causes distention of its lumen and ulceration of mucosa.

Males are more affected than females. Most of the patients lie between 20-40 years of age. Stress, emotional factors and vitamin deficiencies are also associated with this disease.

Symptoms

The symptoms include difficulty in swallowing both liquids and solids associated with regurgitation, retching and chest pain. The solid food usually passes down the sphincter because of its weight and effects of gravity.

Dysphagia for liquids is important and results in pseudo-vomiting containing foul smelling oesophageal contents. Chronic dysphagia for cold food may occur in early life due to failure of relaxation of lower end of oesophagus.

Recurrent respiratory tract infection is seen along with features of anaemia, glossitis, stomatitis and bald tongue. There may be retro-sternal discomfort and radiation of pain to the inter-scapular region.

Following symptoms include malnourishment, ill health and dehydration.

Varieties

Primary oesophageal motility disorder called cardiospasm because of severe spasm of the circular muscle fibres of the lower end of the oesophagus. The contracted segment does not relax during swallowing leading to dilatation and hypertrophy of the oesophagus.

Acquired variety is seen in South American countries and is seen with sleeping sickness (Chagas’ disease), which causes the destruction of the ganglion cells.

Diagnosis

The condition must be differentiated from carcinoma. Diagnostic procedures used are chest x-ray, barium swallow test, gastro-intestinal endoscopy and oesophagoscopy.

Treatment

Treatment procedures include medications and balloon dilatation or surgery in severe cases. The diet advised to the patients comprises of soft foods only.

Complications

The complications that may occur include nutritional deficiencies, aspiration pneumonia, oesophageal carcinoma, bronchiectasis or lung abscess.