Achalasia cardia

Achalasia cardia

1. ACHALASIA CARDIA Primary oesophageal motility disorder Also called as cardiospasm –because of severe spasm of circular muscles of lower end of oesophagus. The contracted segment doesn’t relax during swallowing as a result there is dilatation of, tortuosity and hypertrophy of the oesophagus above

2. Aetiopathogenesis Idiopathic- it occurs due to absence/degeneration of Auerbach’s plexus throughout the body of oesophagus, causing improper integration of parasympathetic impulse Acquired variety- in America, caused by Trypanosoma cruzi which destroys ganglion cells of Auerbach’s plexus.(Chagas disease) Stress Emotional factors Vitamin B1 deficiencies

3. Pathophysiology

4. Clinical features Women around 2 0-40 yrs. of age are commonly affected Female:male::3:2 Progressive Dysphagia -which is more for liquids than solid food. Regurgitation and recurrent pneumonia are common Malnutrition and ill health Retrosternal discomfort - pain also radiates to interscapular region Odynophagia and weight loss

5. Dysphagia Weight loss Regurgitation Triad of Achalasia cardia Staging Proximal dilatation <4cm Dilatation b/w 4-7 cm Dilatation >7cm

6. Investigations Barium swallow- bird beak appearance of lower oesophagus , Dilatation of proximal oesophagus Absence of fundic gas bubble Sigmoid oesophagus X-ray chest- retrocardiac air fluid level lateral view Plain X-ray abdomen erect-fundic air bubble is absent due to stasis of fluid in oesophagus Oesophagoscopy -dilated sac containing stagnant food and fluid due to stasis LES is closed with air insufflation, rosette apperance Oesophageal manometry - Aperistalsis in body of oesophagus Ultrasound- detects subepithelial tumor infiltration in 2ndy achalasia due to distal carcinama

7. Rosette appearance of LES on endoscopy X-ray

8. Treatment Heller’s cardiomyotomy- surgical 7-10cm long incision made through lower oesophageal end and carried over to stomach ,muscles are cut till mucosa bulges out.Myotomy should be extended upto aortic arch and distally up to stomach to 1-2cm below the junction Forceful dilatation- using pneumatic balloon under fluoroscopic control within LOS(300mmhg pressure applied for 15 sec) Injection treatment- inj botulinum toxin is injected in LES endoscopically ,blocks Ach release Drugs- sublingual nifedipine gives short term releif Endoscopic myotomy

9. complications Carcinoma of mid and lower oesophagus due to chronic irritation

10. THANK YOU Gitanjali Kumari 110201312