Achalasia Cardia

Achalasia cardia is a chronic condition of the esophagus in which the lower esophageal sphincter (LES) fails to relax properly during swallowing, and the esophagus loses its normal peristaltic movement. This leads to difficulty in swallowing (dysphagia), food stagnation, and, in severe cases, significant discomfort and nutritional issues.

Key Features

Pathophysiology

1. Failure of LES Relaxation: The LES remains tightly closed instead of relaxing to allow food to pass into the stomach.
2. Loss of Peristalsis: The esophageal body becomes dyskinetic or lacks the coordinated wave-like muscle contractions needed to push food down.
3. Degeneration of Nerve Plexuses: Achalasia is associated with the loss of inhibitory neurons in the myenteric (Auerbach's) plexus.

Causes

• Primary Achalasia: Idiopathic; most common.
• Secondary Achalasia:
  • Chagas Disease (caused by Trypanosoma cruzi).
  • Esophageal cancer or compression by external tumors.
  • Autoimmune or paraneoplastic syndromes.

Symptoms

1. Dysphagia: Difficulty swallowing, initially for solids and later for liquids.
2. Regurgitation: Of undigested food, especially at night or when lying down.
3. Chest Pain: Retrosternal pain or discomfort.
4. Heartburn: A result of food stasis and fermentation in the esophagus.
5. Weight Loss: Due to difficulty eating and malnutrition.
6. Cough or Aspiration: Especially at night, leading to respiratory symptoms.

Diagnosis

1. Barium Swallow (Esophagram):

   • Shows a classic "bird's beak" appearance due to narrowing at the LES.
   • Esophageal dilation with delayed emptying.

2. Esophageal Manometry:

   • Gold standard test.
   • Confirms incomplete LES relaxation and absence of esophageal peristalsis.

3. Endoscopy:

   • Rules out malignancy or structural lesions.

4. CT Scan or MRI:

   • Used to exclude secondary causes like tumors.

Treatment

Achalasia cardia can be treated successfully with Homoeopathic medicines

Complications

1. Esophageal dilation leading to megaesophagus.
2. Aspiration pneumonia from regurgitation.
3. Increased risk of esophageal squamous cell carcinoma with long-standing disease.

Prognosis

With appropriate treatment, most patients experience significant symptom relief. However, regular follow-up is essential to monitor for complications or disease recurrence.