Introduction:
Achalasia cardia is a rare esophageal muscle tissue condition that causes difficulty moving food and liquid from the mouth to the digestive tract. Certain elements of this disease may be adequately mitigated by medications and pneumatic dilatation procedures; nonetheless, surgical intervention may eventually be required for certain people to fully treat their symptoms.
What Is Achalasia Cardia?
Achalasia cardia occurs when there is an issue with muscle function located near the end part of the digestive tract, referred to as the lower esophageal sphincter (LES). This problem causes a build-up of solids and fluids in the throat, making it difficult for people suffering from this condition to swallow anything easily. As time passes, without proper treatment, this can cause unwanted symptoms like chest pain, regurgitation, and severe weight loss. Therefore, seeking medical attention to diagnose and address this condition properly is vital.
What Causes Achalasia Cardia?
The exact cause of achalasia cardia is unknown, but researchers believe it may be related to an autoimmune response or a viral infection. Some of the causes that may cause achalasia cardia are:
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Neural Dysfunction: Achalasia cardia poses difficulties while swallowing due to neural dysfunctions impacting muscles in the lower esophageal sphincter or food pipe conduit (esophagus). The root cause behind these dysfunctions is damage inflicted on ganglion cells found within the food pipe walls responsible for coordinating muscular contractions. Although still a mystery, researchers did not find out possible associations between autoimmune factors and the emergence of achalasia cardia.
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Autoimmune Factors: Although rare, in some cases, the body's immune system wrongly attacks nerve cells in the esophagus, resulting in inflammation leading to muscle dysfunction and difficulty swallowing.
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Genetic Predisposition: Although rare, there have been reports of familial cases of achalasia cardia, suggesting a potential genetic predisposition to the condition. Specific genes associated with the disorder are currently being studied to gain further insights into its inheritance patterns.
How Is Achalasia Cardia Diagnosed?
It occurs at any stage of life but is most commonly seen in adults between the ages of 25 and 60. Diagnosis involves a combination of imaging tests and specialized procedures. To confirm the diagnosis, measuring the pressure in the esophagus and assessing the function of the LES are helpful tests. These tests include:
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Medical History and Physical Examination: A correct diagnosis of achalasia cardia requires healthcare professionals to conduct an extensive medical history review and a thorough physical examination. During this stage of evaluation, patients are questioned about their specific symptoms, such as when they began experiencing them or if any factors are exacerbating them. To supplement these initial steps taken in identifying achalasia cardia further, physicians will often utilize esophageal manometry testing procedures, which can measure both muscle coordination as well as pressure within the esophagus- offering physicians key insight into whether or not achalasia cardia is present.
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Imaging Studies: Multiple imaging tests are available that can help diagnose achalasia cardia. One of these tests is a medical procedure known as a barium swallow or esophagram. During this test, the patient swallows a contrast material, and X-rays are taken to examine the esophagus, identifying any structural or performance-related issues.
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Esophageal Manometry: Esophageal manometry is a diagnostic procedure that measures the pressure and coordination of muscle contractions in the esophagus. It is considered to be the gold standard for diagnosing achalasia cardia. During the test, a tiny tube is introduced through the nose or mouth into the esophagus, and the patient is asked to swallow at various intervals. The recorded data aids in identifying the typical lack of peristalsis and failure of LES relaxation.
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Endoscopy: Endoscopy is a medical procedure where doctors insert a flexible tube equipped with a light and camera, called an endoscope, into the mouth to examine the esophagus and stomach. This procedure is used to thoroughly evaluate the esophagus lining and rule out other possible causes of symptoms. It can also help doctors collect tissue samples if necessary.
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Other Tests: In some cases, additional tests such as esophageal pH monitoring or esophageal impedance can be conducted to assess acid reflux and the movement of fluids in the esophagus.
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Differential Diagnosis: When diagnosing a patient, it is important to distinguish between achalasia cardia and other conditions that may produce similar symptoms, like gastroesophageal reflux disease (GERD), esophageal stricture, or esophageal tumors. A comprehensive approach that involves assessing medical history, performing a physical examination, conducting imaging studies, and administering specialized tests can aid in determining an accurate diagnosis.
Early diagnosis of achalasia cardia is essential for initiating appropriate treatment and preventing complications. A multidisciplinary approach involving gastroenterologists, surgeons, and radiologists is often employed to ensure a comprehensive evaluation.
What Are the Symptoms of Achalasia Cardia?
The symptoms of achalasia cardia can vary from person to person, and the most common symptoms seen in this condition are:
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Dysphagia: Dysphagia, or trouble with swallowing, stands out as the hallmark symptom of achalasia cardia. This may lead to sensations of food getting stuck or moving sluggishly through the esophagus, prompting increased exertion while swallowing.
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Regurgitation: Reflux, which is characterized by the reflexive movement of undigested food or liquid up into the throat or mouth, is a frequently observed symptom. It typically transpires soon after eating or drinking and may lead to an unpleasant sour taste or burning sensation.
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Chest Pain: Many individuals with achalasia cardia experience chest pain or discomfort, often described as a squeezing or pressure sensation. This pain is usually felt in the chest area and can radiate to the back or neck.
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Weight Loss: Over time, the difficulty in swallowing and regurgitation can lead to weight loss and malnutrition. In severe cases, individuals may struggle to maintain healthy body weight due to inadequate intake of nutrients.
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Other Symptoms: Additional symptoms can include persistent coughing, hoarseness, heartburn, and nocturnal choking episodes. These symptoms may arise as a result of the regurgitated material irritating the airways.
What Is the Treatment for Achalasia Cardia?
Non-surgical treatments such as medication and pneumatic dilation are often effective in treating achalasia cardia. Nitrates and other medications that relax the esophageal muscles can enhance the flow of food into the stomach. Pneumatic dilation involves using a balloon to stretch the LES and improve its function. While these treatments are often successful, some individuals may require surgery if they do not respond to non-surgical options.
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Surgery for Achalasia Cardia: When treating achalasia cardia, surgeons typically perform a procedure known as a Heller myotomy. To enhance the functioning of the lower esophageal sphincter (LES), surgeons typically make small incisions in the abdomen and use a laparoscope to access it. During the procedure, the muscles of the LES are cut, and a partial fundoplication may be performed to prevent acid reflux.
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Peroral Endoscopic Myotomy (POEM): The surgeon uses an endoscope to access the esophagus and perform the myotomy during this procedure. This approach is less invasive than a laparoscopic myotomy but requires specialized training and equipment.
Conclusion:
Achalasia cardia is a rare condition that can cause significant discomfort and difficulty for individuals. While non-surgical treatments are often effective, surgery may sometimes be necessary. Surgery for achalasia cardia typically involves a myotomy, which can be performed laparoscopically or using an endoscope. While surgery is generally safe and effective, individuals should be aware of the potential complications and take precautions to ensure a successful recovery. Anyone experiencing achalasia cardia symptoms should seek medical attention to acquire an accurate diagnosis and discuss treatment options.
