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Balachandran Premkumar, Subhankar Paul 10.5005/jp-journals-10033-1318
RevieW ARticLe

Achalasia Cardia: Revisited

1 Balachandran Premkumar, Subhankar Paul
2

ABSTRACT

Introduction: Achalasia cardia is a very common esophageal
motility disorder affecting a large population worldwide including
the Indian subcontinent. The diagnosis of the condition is equally
important as the treatment ranges from medicines to botulinum
injection, to pneumatic dilatation and surgery. This study gives
an overview of achalasia cardia and the modalities to diagnose
and treat the condition.
Keywords: Achalasia cardiae, Cardiospasm, Esophageal
achalasia, Esophageal peristalsis.

How to cite this article: Premkumar B, Paul S. Achalasia
Cardia: Revisited. World J Lap Surg 2017;10(3):112-116.
Fig. 1: Lower esophageal sphincter
Source of support: Nil
Conflict of interest: None
DIFFERENTIAL DIAGNOSIS

INTRODUCTION A few other conditions may mimic the symptoms of
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achalasia cardia, such as
Achalasia cardia is an esophageal motility disorder in • Gastroesophageal reflux disease (GERD),
which the smooth muscle layer of the esophagus loses • Hiatus hernia, and
normal peristalsis and the lower esophageal sphincter • Psychosomatic disorders.
(LES) fails to relax properly in response to swallowing
(Fig. 1). 1-3 INVESTIGATIONS

Specific tests for achalasia are barium swallow and
SYMPTOMS
esophageal manometry. In addition, endoscopy, with or
The main symptoms of achalasia are dysphagia (difficulty without endoscopic ultrasound, may be done to rule out
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in swallowing) and regurgitation of undigested food. the possibility of cancer. 4
Dysphagia tends to become progressively worse over
time to involve both fluids and solids. Some achalasia Barium Swallow
patients also experience weight loss, coughing when The classical “Bird’s beak” or “Rat’s tail” appearance may
lying in a horizontal position, and chest pain which may be seen. An air-fluid margin is often seen over the barium
be perceived as heart burn. The chest pain experienced, column due to the lack of peristalsis. 8
also known as cardiospasm and noncardiac chest pain A 5-minute timed barium swallow can provide a
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(NCCP), can often be mistaken for a heart attack. It can useful benchmark to measure the effectiveness of treat-
be very painful in some sufferers. The food and liquid, ment. It also shows aperistaltic contractions, increased
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including saliva, are retained in the esophagus and may intraesophageal pressure, and failure of relaxation of the
cause aspiration. 6
LES (Fig. 2). 10

2
1 Consultant, Registrar Esophageal Manometry
1,2 Department of General Surgery, Apollo Hospitals, Chennai Because of its sensitivity, manometry is considered the
Tamil Nadu, India key test for establishing the diagnosis. Manometry
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Corresponding Author: Balachandran Premkumar, Consultant reveals failure of the LES to relax with swallowing and
Department of General Surgery, Apollo Hospitals, Chennai, Tamil lack of functional peristalsis in the smooth muscle of
Nadu, India, e-mail: drbpk@hotmail.com
esophagus (Graph 1). 12

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