#achalasiacardia #esophagus #kimshospitals
Lets discuss about a rare problem called Achalasia Cardia, it is a rare problem which affects the food pipe or the esophagus. Food pipe connects the throat to the tummy,it doesnt work as a pvc pipe, food doesnt just fall into the stomach, the food is caught by this pipe and actively pushes the food down when one swallows the food from the throat to the tummy.For a food ball to reach the tummy the food pipe must be muscularly very actively squeeze the food down, to active this there is a set of muscles covering the food pipe and these muscles are controlled by a circuit of nerves. The nerves activates rhythmically that cause the food pipe to contract ina very programmed way to push the food down. Due to some unknown reasons the neural network or wiring of the food pipe starts dying, and when this happens the muscles can no longer push the food down it stands static, and the esophagus becomes like a pvc pipe and the food dropped on the top just goes down due to gravity, this condition is called Achalasia Cardia, wherein the food pipes contracting power has become extremely weak, there is also a second problem to it, the lower end of the food pipe is a valve which stops the acids from coming out. So, people with Achalasia Cardia have not only reduced pushing power of the food pipe , but also a very tight valve is developed, so the combination of poor pressure from top and tight lower valve makes it very tough for them to swallow the food. Most patients with Achalasia Cardia have poorly functioning food pipe, along with it the lower valve also becomes tight, they come to the doctor with a difficulty in swallowing, thus they take more and more time to eat the food, they also have food which doesn’t go immediately to the stomach rather gets stuck in the chest area, during the time after eating if they bend down food can regurgitate and come out. Few symptoms include regurgitate, cough, unable to eat so loosing weight.
For Diagnosis, the important tests are
1. Barium test: where the patient is asked to swallow a white paste or barium paste.Next day an X-ray is taken and in the patients the barium is seen stuck above the valve it doesnt go down.
2. Endoscopy : An endoscopy can not only diagnose Achalasia Cardia it can also check for other problems such as cancer.
3. Manometry test: It is a very sophisticated test where in we study the pressure wave on the esophagus and find out how much pushing power is there in the esophagus.
These are the main ways in which the Achalasia Cardia is diagnosed in patients.
There are various options once Achalasia Cardia is detected in the patient:
1. Medicines : They relax the lower valve and thereby allow the patient to swallow, the success rate of these medicines is very low. Unlikely that patient will have long standing relief of symptoms by taking pills. The pills cannot as such cannot enter the stomach because of the problem and thus pills effect is lower.
2. Edoscopy with balloon: Using an endoscope a balloon is passed into the pipe and the ballon when it reaches the valve is inflated, which stretches and opens the lower valve which then allows the food to go through. This treatment is not known to have a lasting effect, it may last for one two years but the symptoms will come back.
3. Edoscopy Poem : An endoscope is passed and through the endoscope a surgical procedure is carried out wherein the muscle rings which make the lower valve is cut to release the pressure thereby they are opened out.
4. Laparoscopic Myotomy : With the help of key hole operation where two or three small holes are made in the tummy and the lower end of the food pipe where the sphincter fibers are there, they are opened up, the food can thus go easily down. Now since the valve is no longer closed there are chances of acid coming up which becomes a two way pathway which is not good. Thus a procedure is done to create a mechanism such that abnormal acid reflex doesn’t happen in the reverse way. So we try and recreate the original mechanism in which food goes from top to bottom but acid doesn’t come out from bottom to top.
Dr. G. Parthasarathy
Sr. Consultant, Surgical Gastroenterology, Laparoscopic & Hepato-Pancreaticobiliary Surgery
@KIMS Hospitals Secunderabad
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Негізгі бет Causes, symptoms, Diagnosis &Treatment of achalasia cardia | Dr. G. Parthasarathy | KIMS Hospitals
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