Page 32 - WJOLS - Journal of Laparoscopic Surgery

WJOLS

Achalasia Cardia: Revisited
MANAGEMENT

Medications
• Drugs that reduce LES pressure are useful at early
stages. These include calcium channel blockers,
such as nifedipine and nitrates, such as isosorbide
13
dinitrate and nitroglycerin. Sublingual nifedipine
significantly improves outcomes in 75% of people with
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mild or moderate disease. However, many patients
experience unpleasant side effects, such as headache
and swollen feet, and these drugs often stop helping
after several months. 4
• Botulinum toxin (Botox) may be injected into the LES
to paralyze the muscles holding it shut. The effect
Fig. 2: Bird’s beak appearance
is only temporary and lasts about 6 months. Botox
injections cause scarring in the sphincter which may
Endoscopy increase the difficulty of later Heller myotomy. This
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therapy is only recommended for patients who cannot
The internal tissue of the esophagus in achalasia cardia,
generally, appears normal in endoscopy, although a “pop” risk surgery, such as elderly persons in poor health. 16
may be observed as the scope is passed through the non-
relaxing LES with some difficulty, and food debris may Pneumatic Dilatation
be found above the LES. • Pneumatic dilatation is most effective in the long
term, in patients over the age of 40; the benefits tend
Biopsy
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to be shorter lived in younger patients. It may need
Biopsy from the esophagus shows hypertrophied muscu- to be repeated with larger balloons for maximum
18
lature and absence of certain nerve cells of the myenteric effectiveness. Also in balloon pneumatic dilatation,
plexus, a network of nerve fibers that controls esophageal a small risk of a perforation requires immediate surgi-
peristalsis. cal repair. Pneumatic dilatation causes some scarring

Graph 1: Manometry reading
World Journal of Laparoscopic Surgery, September-December 2017;10(3):112-116 113