ACHALASIA CARDIA

Esophagus is a tube that carries food from the throat to the stomach. Achalasia is a condition that affects the lower esophageal sphincter LES (the valve between esophagus and stomach) and it fails to open up during swallowing which it is supposed to. This leads to hold up of food within the esophagus and a feeling of dysphagia. In some patients esophageal motility is also affected and as a result, the food is not pushed down the food pipe resulting in dysphagia.

Patients with achalasia complain of difficulty in swallowing food or feel like the food is stuck in their food pipe. They also complain of regurgitation or back flow of food or liquids they had in their meals during sleep or while lying down. Due to prolonged dysphagia most of the patients have significant weight loss. Some patients may also complain of pain or discomfort in the chest more so after eating.

Besides the typical complains as described above, the diagnosis is usually by a X-ray (Barium swallow) which tracks the movement of barium in the food pipe. Upper GI Endoscopy is necessary is needed to rule out other causes of dysphagia. Esophageal Manometry records the muscle activity of esophagus and confirms the diagnosis.

Treatment of Achalasia involves treating the lower esophageal sphincter(LES). First line therapy is Pneumatic Dilatation, whereby a balloon is inserted in the esophagus and inflated. This stretches the sphincter and helps esophagus to function better. Other non-surgical option is to inject the Botox in the LES through the endoscope. This relaxes the sphincter and relieves dysphagia. However multiple Botox sessions are needed over the period of time for long term results.

Surgical treatment for Achalasia cardia is Esophago-myotomy, wherein the muscular LES is incised which weakens / relaxes it and the food can then pass down in the stomach comfortably. It is usually done laparoscopically resulting in minimal pain, small surgical scar and early discharge. The results of surgery are excellent in properly selected cases and the relief from dysphagia is almost immediate.