Achalasia occurs when the patient’s smooth muscle fibers fail to relax causing the sphincter to remain closed. Achalasia Cardia is the achalasia of the esophagus or esophageal achalasia. This disorder affects the smooth muscle layer of the esophagus and the lower esophageal sphincter. Incomplete relaxation of the lower esophageal sphincter affects the ability of the smooth muscles in the esophagus to move food down to the stomach.
Chest Pain especially behind the sternum.
2. Difficulty in swallowing food or while drinking fluids (Dysphagia).
3. A constant feeling of food stuck in the esophagus.
4. Severe pain after eating.
6. Acid reflux.
7. Weight loss.
8. Coughing sensations when patients lie down.
9. Experiencing aspirations (food and liquids that remain retained in the esophagus may be inhaled into the lungs).
1. As secondary to other medical conditions like the Chagas disease or Esophageal Cancer.
2. Hereditary reasons.
3. Autoimmune conditions.
4. Degeneration of nerves in the esophagus.
1. Esophageal Manometry – Esophageal manometry is one of the key procedures used to diagnose achalasia cardia. It consists of a catheter that is inserted to the nose. This instrument measures the muscle contractions in various parts of the esophagus while the patient is instructed to swallow multiple times thus revealing failure of the lower esophageal sphincter to relax.
2. Barium Swallow Radiography – This method of diagnosis requires the patient to swallow a barium solution before a continuous X-ray (fluoroscopy) is carried out. The x-ray allows the doctor to observe how the fluid flows through the esophagus.
3. Endoscopy – Endoscopy of the esophagus, stomach and the duodenum is usually carried out to check for cancerous growths. An endoscopy is performed with the help of a specialized instrument called an endoscope. The endoscope has a thin flexible tube with a tiny camera attached to one end. It is inserted into the mouth down the esophagus. The doctors can view magnified images on a monitor and use forceps or scissors on the instrument to remove some tissue for a biopsy.
1. Medication – Medication that helps reduce pressure on the lower esophageal sphincter may be prescribed. Botox treatment may be used to paralyze the muscles that cause the lower esophageal sphincter to stay closed.
2. Pneumatic Dilation – This method of treatment requires dilating or stretching the esophageal muscle fibers by placing a balloon inside the lower esophageal sphincter and inflating it forcefully. This helps the esophagus function better.
3. Pre-oral Endoscopic Myotomy – Also known as POEM, it is a Minimally Invasive Surgery that is similar to the Heller Myotomy. Here, an endoscope is inserted through the mouth to make a small incision made on the esophageal mucosa. The surgeon then divides the innermost circular muscle extends it through the lower esophageal sphincter to a few centimeters into the gastric muscle.
4. Heller’s Cardiomyotomy with Fundoplication – This surgery is carried out laparoscopically. It involves making a cut on the muscle layer that keeps the sphincter closed at all times. This cut is made along the length of the esophagus starting a little above the lower esophageal sphincter extending down to the stomach without damaging the mucosal layer. A partial wrap (Dor’s fundoplication) is then added to avoid excessive reflux in the esophagus. Laparoscopy provides for excellent visualization and much superior exposure compared to the previous conventional open surgery.
Dr. Nikhil Agnihotri, expert Laparoscopic Surgeon provides Achalasia Cardia Treatment and Heartburn Treatment in Delhi, India. Contact us to know more about treatment and cost.