In addition, the valve between the esophagus and the stomach (lower esophageal sphincter) does not relax enough during swallowing to allow food to enter the stomach.

What is cardiac achalasia?

In the esophagus there are muscles and nerves to facilitate movement.

The nerves coordinate the relaxation and the opening of the sphincters as well as the peristaltic waves in the esophagus. 
Achalasia affects both the muscles and nerves of the esophagus, especially the nerves that relax the sphincter between the esophagus and the stomach. The muscles do not contract properly so the peristalsis (rhythm of muscle contraction of the digestive organs) that allows food to pass through the esophagus becomes difficult. 
However, the effects on the nerves are considered more serious. 
At the onset of achalasia, inflammation can be seen in the lower esophageal muscle when examined under a microscope.
With the progression of the disease, the nerves begin to degenerate and eventually disappear, particularly the nerves that cause relaxation of the lower esophageal sphincter. 
Over time the muscle cells begin to degenerate, this is the consequence of nerve damage. The result of these changes is the inability to relax the sphincter muscles and muscles in the lower esophagus. If the sphincter does not relax properly, food can not pass easily through the stomach. This makes it difficult to swallow the food. Over time, the body of the esophagus extends and dilates.


What are the causes of cardiac achalasia?

The cause of achalasia is unknown. There are theories about the risk factors: infection, inheritance or an autoimmune disease that causes damage to the body of the esophagus. 
Researchers think it may be related to a virus and some recent studies show that achalasia is caused by nerve cells of the involuntary nervous system that are inside the muscular layer of the esophagus. These cells are attacked by the patient’s immune system and slowly degenerate for reasons that are not yet clear.


Risk factors for achalasia

Achalasia is a rare disorder, it can occur at any age but is more common in middle-aged or elderly adults.


What are the symptoms of cardiac achalasia?

Acalasia symptoms can begin when children or they may develop gradually in childhood or in adulthood. The most common symptoms are:


Possible Complications

  • Regurgitation of acids or solid food from the stomach into the esophagus,
  • Breathing the food and make you go to the lungs, it can cause pneumonia by aspiration.
  • Perforation of the esophagus


The diagnosis of cardiac achalasia


The symptoms of achalasia are similar to gastroesophageal reflux , hiatal hernia and some psychosomatic disorders. 
This disease is often confused with something else. 
Your doctor may prescribe the following diagnostic tests:

Radiography  with barium – the patient should swallow a white liquid solution known as barium sulphate.Barium sulphate is visible on radiography. 
When the patient ingests this substance, the esophagus is covered with a thin layer of barium, allowing the cava structure to be seen with radiography.

The esophageal manometry is performed to measure the pressure and the movement of the esophagus. A device called a pressure gauge is used. 
Your doctor can do this to rule out cancer. 
A thin tube passes through the nose of the patient who must swallow several times. 
The device measures muscle contraction in various parts of the esophagus. 
This procedure helps the doctor determine if the lower esophageal sphincter is properly relaxed while the patient swallows. 
You can also tell how much smooth muscle is working.

Biopsy – is not used frequently for the diagnosis of achalasia. A sample is removed during endoscopy.


Treatment for achalasia of the cardia

Therapy for achalasia is found in the relaxation or closure of the valve between the esophagus and stomach (lower esophageal sphincter) until food and liquids can move more easily through the digestive tract. The specific treatment depends on the age and severity of the disease.

Options include:

Surgery. Surgeons use a minimally invasive procedure called Heller’s esophagocardiomyotomy to cut the lower esophageal sphincter muscle. 
People who undergo this surgery in turn may develop gastroesophageal reflux disease.

To avoid reflux problems, surgeons may perform a second procedure called fundoplication (see the hiatal hernia page) during surgery  while  cutting the esophageal sphincter muscle. 
Surgery may be the preferred option for young people, though research shows that it can be effective even in the elderly.


Dilation with balloon. A balloon is inserted into the esophageal sphincter and swells to enlarge the opening. This procedure should be repeated if the esophageal sphincter does not remain open. Some people may feel good until 10 or 15 years before having to repeat balloon dilation.

Botox ( botulinum toxin ). This muscle relaxant can be injected directly into the esophageal sphincter with an endoscope. 
Studies indicate that sometimes injections should be repeated, it can also make successive surgery more difficult if necessary. 
The guidelines recommend the use of botox for the elderly and those who are not good candidates for surgery.


What is the long-term perspective for a child with achalasia?

Although there is no treatment for this disease, surgery can help most people with achalasia to live a normal life.

After Surgery 
There are some things that can be done after dilation or surgery to reduce the symptoms:

  • Chew the food well
  • Use time to eat
  • Drink lots of fluids during meals
  • Always eat sitting upright
  • Use different pillows or lift the head of the bed, so it sleeps in an upright position and prevents the penetration of acid into the esophagus that causes heartburn.

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