Achalasia Cardia is a rare disorder of the esophagus or food pipe, characterized by difficulty in swallowing the food. In normal conditions, swallowed food passes through food pipe into the stomach. This requires coordinated action of esophagus known as peristalsis and relaxation of lower esophageal sphincter known as lower esophageal sphincter (LES). In patients with achalasia cardia, both the contraction of esophagus muscle and relaxation of LES are defective, leading to difficulty in swallowing food. Patient usually complaint of choking sensation after swallowing of food or liquids. what causes achalasia cardia : Exact Etiology of achalasia cardia is unknown, however various virus infections has been implicated in causing achalasia cardia.
Symptoms of achalasia Cardia
1. Difficulty in swallowing food, both for solids and liquids. Many time patient modify their diet, take more water to assist swallowing or perform various manoeuvres such as raising shoulders to assist swallowing. Many times patients take longer time to finish food. In social gatherings, patients are not able to take adequate food, leading to dissatisfaction. Many patients, tend to avoid social meeting to avoid such circumstances.
2. Regurgitation of food, liquid food coming back from mouth or nose specially during night. Food and liquids swallowed during day are not able to move down in stomach and get accumulated in food pipe. When patient lies down, the liquid food may come back through mouth or nose and will cause awakening from sleep.
3. Recurrent chest infection : Food from esophagus may move upward and pass in food pipe and lungs. This condition may lead to recurrent episodes of chest infections.
4. Weight loss due to poor oral intake : If condition is untreated, due to poor oral intake, patient may suffer from weight loss.
Diagnosis
Upper GI endoscopy
Barium swallow
Esophageal manometry : If achalasia cardia is suspected during endoscopy, next test should be esophageal manometry. Esophageal manometry should be performed in conscious state as patient has to swallow water during manometry. During manometry, catheter is passed through the nose in esophagus. Initially baseline pressures are recorded, after that patient take multiple swallows of water. After swallow, pressures in food pipe and lower esophagus sphincter are measured. Based on Chicago 4 classification, diagnosis of achalasia cardia is confirmed. Achalasia cardia has three types, which can be easily diagnosed on manometry
Treatment
Per Oral Endoscopic Myotomy (POEM):
POEM is a minimally invasive endoscopic procedure designed to address the motility issues associated with Achalasia Cardia. Unlike traditional surgical interventions, POEM does not require external incisions. Instead, it is performed entirely through the mouth, using an endoscope to access and treat the affected areas.
Procedure:
• Once diagnosis is confirmed, patient is admitted for 48-72 hours for performing this procedure. : Patient is first evaluated for fitness of procedure by anaesthesia time. After fitness for the procedure, POEM is performed under general anesthsia, no pain occur while performing the procedure.
• Endoscope Insertion: The endoscope is carefully introduced through the patient's mouth and guided down into the esophagus. Using the endoscope, a small incision and tunnel is created in esophageal wall, followed by cutting the muscles of tight esophageal sphincter. Last step is closure of the initial incision with the help of clips. Clips don’t cause any pain or difficulty in swallowing and may fall off spontaneously in most of patients in next 3-6 months.
• POEM is safe procedures and thousands of procedure have been performed across the globe safely.
Pneumatic balloon dilatation
Surgery
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Best wishes
Vikas Singla