Pathophysiology of Achalasia Cardia

What is an esophagus?

An esophagus, commonly known as the food pipe, is an 8 m long muscular tube that connects the throat to the stomach. It is lined by a soft tissue known as the mucosa. It also prevents the food and secretions from going into the windpipe. Sometimes the muscles of the esophagus can degenerate and cause some life-threatening problems. So let’s understand step by step about the esophagus.

What are the different parts of the esophagus?

  • The upper esophageal sphincter (UES)- The sphincter is a ring of muscle that separates the esophagus from the throat. Most of the time it remains closed to prevent food in the main part of the esophagus from backing up.
  • Body of the esophagus- It is a tube that is approximately 8 inches in length. It is the main part of the esophagus which is long as well as muscular.
  • The lower esophageal sphincter (LES)- Just like the UES, the lower esophageal sphincter is a ring of specialized muscle at the junction of the esophagus with the stomach. It prevents food and acid from going back into the esophagus from the stomach.

How normal esophagus functions?

You must be wondering how an esophagus works? A normal esophagus functions in 3 parts-

  • As soon as food and saliva are swallowed the upper sphincter relaxes to allow the passage from the throat into the esophageal body.
  • Then the muscles in the upper esophagus which is just below the upper sphincter contracts to allow food and saliva to pass further down into the esophageal body.
  • The ring-like contraction of the LES progresses down the body of the esophagus that propels the food and saliva towards the stomach.

Achalasia Cardia

Achalasia Cardia is defined as the weakening of the muscles in the esophagus which prevents food and saliva to pass into the stomach. It is also known as esophageal achalasia. It is one of those diseases that generally occur in adults but in some cases, it is also seen in children. It. Although the exact cause of achalasia cardia is unknown, some doctors argue that the main cause of achalasia cardia is the degeneration of the esophagus, muscles as well as the nerves that control these muscles. Some of the common symptoms that are seen in individuals who suffer from achalasia cardia are:

Dysphagia is difficulty in swallowing food and saliva
  • Dysphagia is difficulty in swallowing food and fluid
  • Chest pain as well as discomfort
  • Loss of weight due to reduced intake of food
  • Regurgitation, which is bringing up swallowed food up again to the mouth
  • Heartburn, although this is not a characteristic exclusive to achalasia cardia

Diagnosis

Heartburn

In order to diagnose and evaluate a swallowing problem, the following three tests are commonly used:

  • Manometry. This test is used to measure muscle pressure and movements. This test is carried out by a pressure measuring tool which is known as a manometer.
  • Endoscopy. To undergo an endoscopy, the patient is sedated first. In endoscopy, a camera on a thin, lighted tube is passed down the digestive channel which projects signs of achalasia. It also reveals any inflammation, ulcers or tumors.
  • X-ray and Barium swallow test- A patient is asked to consume a white solution known as barium sulfate which is visible to X-rays. As a patient consumes, the food pipe is coated with a layer of barium, enabling the hollow structure to be observed.

Treatment

Drug medication

After the appropriate diagnosis of achalasia cardia, doctors recommend their patients with two types of drugs- nitrate and calcium channel blockers to relax the lower esophagus sphincter muscle. This has not proven to be so effective as these have caused some unpleasant side effects such as headaches and low blood pressure in some patients. For permanent cure, doctors suggest surgery over drug medication.

Laparoscopic Surgery

At present, selected patients suffering from achalasia can be treated successfully by a minimally invasive surgical technique called the Heller Myotomy. Using five small incisions, a Heller myotomy or laparoscopic esophagomyotomy can be accomplished. This operation is a one-day procedure which means the patients require only one day of hospital stay and recovery is accelerated when compared to traditional surgery.

Almost two-thirds of patients are treated successfully with surgery. However, some patients need to repeat the surgery or undergo balloon dilation to achieve long-term results.

Balloon dilatation

In simple terms, balloon dilatation allows doctors to dilate, or stretch a narrowed area of the esophagus. To disrupt the spastic muscle at the lower esophageal sphincter in order to treat achalasia, a balloon dilator is used. A balloon dilator is a soft inflator with an inflatable “balloon” at its tip. Some risks involved with esophageal dilation include difficulty breathing, fever, chest pain or bloody or black bowel movements.

After the surgery, it is better to avoid certain foods such as citrus fruits, alcohol, caffeine, chocolate, etc. It is also recommended to avoid spicy foods. Our doctors at Pristyn Care provide a diet plan after surgery so that you have an easy recovery. We only use the latest laparoscopic procedures to cure esophageal disorders.

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