What is achalasia cardia?
Achalasia cardia is an esophageal motility disorder characterized by
abnormal esophageal peristalsis (esophageal contractions responsible for propulsion of food into the stomach) and
inadequate relaxation of the lower esophageal sphincter (LES - band of muscle fibers which form a sphincter between the esophagus and stomach – prevents acid reflux from the stomach)
What are the symptoms of achalasia?
Difficulty in swallowing (dysphagia) – both solids and liquids, chest pain, regurgitation of food, heartburn, and weight loss
What causes and how common is achalasia cardia?
Etiology remains unknown, but pathology is due to loss of nerve cells within the distal esophagus and LES.
Achalasia is a rare disorder affecting 0.03 to 1.63 per 100,000 persons per year and 1.8 to 12.6 per 100,000 persons per year
How is achalasia diagnosed?
Endoscopy – shows varying degrees of esophageal dilatation, pooling of secretions and abnormal contractions. However endoscopy may be normal, most of the times.
Esophageal manometry – is used for the diagnosis and is considered gold standard test for the diagnosis of achalasia. It measures the pressure/ relaxation of the LES and esophageal peristalsis.
Barium swallow
Who treats achalasia cardia?
Gastroenterologist - physician who specializes and trained in disorders and conditions of the gastrointestinal tract. Gastroenterologists perform various interventional procedures related to the gastrointestinal tract such as endoscopy, colonoscopy, EUS and ERCP
What are the treatment options for achalasia cardia?
Oral medications, botulinum toxin injection, pneumatic dilation (PD), laparoscopic Heller myotomy (LHM), Per oral endoscopic myotomy (POEM)
Botulinium toxin is a medication that is injected in the lower esophageal sphincter during endoscopy to impair contraction of the muscle which helps swallowing.
Pneumatic dilation is an endoscopic procedure that using a large balloon to disrupt the lower esophageal sphincter muscle.
Laparoscopic Heller Myotomy (LHM) is a surgical procedure using small incisions to cut the lower esophageal sphincter muscle.
Per oral endoscopic myotomy (POEM) is an endoscopic procedure in which a tunnel is
made to access and cut the lower esophageal sphincter muscle.
Is surgery needed in the treatment of achalasia?
POEM procedure has the best long term outcomes for achalasia and it is minimally invasive procedure with no external incisions and shorter hospital stay. POEM when compared to Laparoscopic heller myotomy has better outcomes and less long term recurrence rates.
Effectiveness of Therapies for achalasia?
The effective and durability of achalasia treatments vary based on the specific therapy. Medications can range in effectiveness from 0-87%. Botulium toxin injection can range in effectiveness from 46.6-78.7%. Pneumatic dilation 50-93%. Surgery 60-94%. POEM >90%.
What are the risks/ complications of achalasia cardia?
Achalasia can lead to decreased quality of life, poor nutrition and damage to the esophagus.
Patients with long standing achalasia can have complications of megaesophagus and squamous cell carcinoma
