Achalasia Cardia

What is Achalasia Cardia

Achalasia cardia means a rare condition affecting the esophagus, where the lower esophageal sphincter (LES) fails to relax properly, making it difficult for food and liquids to pass into the stomach. What is achalasia cardia is often asked when patients experience difficulty in swallowing and are diagnosed with this motility disorder. One effective option in the treatment of achalasia cardia is Per Oral Endoscopic Myotomy, commonly known as POEM.

Achalasia Cardia Cause

The main achalasia cardia cause is the improper relaxation of the LES. LES is a ring-like muscle located between the esophagus and the stomach. It normally opens when we swallow, allowing food and liquid to enter the stomach. At other times, it remains closed to prevent the contents of the stomach from moving back into the esophagus. Achalasia cardia causes this function to be disrupted, leading to food getting stuck and discomfort after meals.

Achalasia Cardia Symptoms

The symptoms of achalasia cardia can vary from person to person, but the most common ones include:

• Dysphagia: Trouble swallowing food or water

• Odynophagia: Painful swallowing, especially with solid foods

• Chest pain: Often felt in the center of the chest after eating

• Weight loss: Long-standing disease can result in reduced intake and nutritional issues

These are some of the most typical achalasia cardia symptoms that prompt people to seek medical advice.

Diagnosis

To confirm the condition, several tests are used. An upper GI endoscopy is performed to rule out any physical blockage. One of the key tests for achalasia cardia radiology is the achalasia cardia barium swallow, where the patient drinks a contrast liquid and X-rays are taken to visualize how it moves through the esophagus. In addition, achalasia cardia x ray imaging helps identify any unusual narrowing or widening of the esophagus. High-resolution esophageal manometry is another specialized test used to assess the movement of muscles in the esophagus.

Achalasia Cardia Types and Pathophysiology

There are different achalasia cardia types, depending on how the esophagus muscles behave during swallowing. The achalasia cardia pathophysiology involves the loss of nerve cells in the esophageal wall, which disrupts normal muscle contractions and prevents the LES from opening as it should.

Treatment of Achalasia Cardia

Several options are available for the treatment of achalasia cardia:

• POEM (Per Oral Endoscopic Myotomy): A modern, endoscopic technique where the tight muscle fibers at the gastroesophageal junction are carefully cut. The patient is typically hospitalized for 48 hours. After 24 hours, an achalasia cardia x ray is done to check the esophagus, and a liquid diet is started.

• Endoscopic Pneumatic Balloon Dilatation: A procedure where a balloon is inserted and inflated to stretch the LES.

• Botulinum Injection: Temporary relief can be achieved by injecting Botox into the LES to reduce its tightness.

• Surgery – Lap Heller’s Myotomy: Traditional achalasia cardia surgery that involves cutting the muscle of the LES through a laparoscopic approach.
  
  

Per Oral Endoscopic Myotomy (POEM):

POEM is a minimally invasive endoscopic procedure designed to address the motility issues associated with Achalasia Cardia. Unlike traditional surgical interventions, POEM does not require external incisions. Instead, it is performed entirely through the mouth, using an endoscope to access and treat the affected area.

POEM Procedure:

• Anaesthesia: The procedure typically takes place under general anaesthesia to ensure the patient’s comfort.
• Endoscope Insertion: The endoscope is carefully introduced through the patient’s mouth and guided down into the esophagus.
• Myotomy: Using the endoscope, the doctor makes a small incision in the inner lining of the esophagus. Subsequently, they create a tunnel within the muscle layers, extending into the lower esophageal sphincter.
• Muscle Cutting: The muscular fibres responsible for dysfunctional motility are precisely cut, allowing for easier passage of food into the stomach.
• Closure: Once the myotomy is completed, the incision is closed with clips or other methods, ensuring the integrity of the esophageal wall.
  
  

Advantages of POEM Procedure:

• Minimally Invasive: As a purely endoscopic procedure, POEM eliminates the need for external incisions, reducing the risk of complications and expediting recovery.
• Customization: POEM allows for a tailored myotomy, enabling the doctor to address the specific needs of each patient.
• Quick Recovery: Patients often experience a faster recovery compared to traditional surgical interventions.

Post-Operative Care:

• Patients are usually kept in the hospital for 2-3 days for monitoring.
• A liquid or soft diet is recommended initially, gradually transitioning to regular foods.
• Follow-up appointments and tests may be scheduled to assess the effectiveness of the procedure.

Considerations: While POEM is generally considered safe and effective, all medical procedures carry some risks. Potential complications include bleeding, infection, and perforation of the esophagus. Patients should discuss the potential risks and benefits with their doctor.

Conclusion: Per Oral Endoscopic Myotomy has emerged as a promising treatment option for Achalasia Cardia, offering a less invasive alternative to traditional surgical interventions. Its success lies in its ability to provide relief from the symptoms of Achalasia while minimizing the impact on the patient’s overall well-being. As with any medical procedure, individual experiences may vary, and consultation with a doctor is crucial for personalized advice and guidance.