Achalasia Cardia: Symptoms, Diagnosis & Treatment

Observed in approximately 12-16 individuals per 100,000, achalasia cardia, is a rare motility disorder that impacts the oesophagus. In the oesophagus, there is a muscle called the lower esophageal sphincter (LES), which encircles the lower part of the oesophagus just above the stomach. Upon contraction, the LES effectively closes the oesophagus.

The swallowing process initiates a wave of esophageal contractions called peristalsis that facilitates food movement along the oesophagus into the stomach. Normally, during peristalsis, the esophageal sphincter undergoes relaxation, allowing food to be moved into the stomach.

What is Achalasia Cardia?

Achalasia is a condition where the normal esophageal peristalsis and the lower esophageal sphincter relaxation are impaired. This condition affects the nerves and muscles of the oesophagus, making it difficult for food and liquid to pass into the stomach. Achalasia cardia treatment often involves a multidisciplinary approach, including the expertise of a gastroenterologist.

Achalasia Cardia Causes

It has been over three centuries since the symptoms of achalasia disease were initially described and this condition was identified. Despite this, the exact cause of the disease remains unknown. Several researchers have suggested that the condition's cause may result from a previous infection. Others have pointed to autoimmune or genetic causes, end result being progressive degeneration of neurons in Esophageal wall and failure of relaxation of LES.

Achalasia Cardia Symptoms

Achalasia cardia is a progressive condition characterised by several symptoms:

• Dysphagia: Inability to swallow food or drink, giving a sensation of a blockage in the food pipe or food getting stuck in the throat.
• Regurgitation: Backing up of food that accumulates in the oesophagus. In the early stages, this is often confused with GERD (Gastroesophageal Reflux Disease).
• Chest Pain, Heartburn, and Belching: Symptoms that mimic GERD, making the early diagnosis of Achalasia challenging.
• Nocturnal Coughing: Persistent coughing at night.
• Aspiration: Involuntary passage of food or drink into the lungs, leading to pneumonia.
• Weight Loss: Caused by the inability to consume food properly.

Achalasia Cardia Diagnosis

In the early stages, diagnosing achalasia disease often requires the elimination of other diseases with similar symptoms and thorough testing. Achalasia is often mistaken for GERD or even a heart attack. Your doctor at Max Healthcare will take a complete medical history and understand the symptoms before establishing a diagnosis. These are some of the tests the doctor may recommend - 

• Endoscopy - Endoscopy involves introducing a thin tube with a camera down the mouth, into the oesophagus, and the stomach. This helps the doctor visualise the upper GI tract and take samples of any abnormal tissue. These can help differentiate between Achalasia and other disorders of the oesophagus.
• Esophageal Manometry - Esophageal manometry can help the doctor measure the change in pressure in the esophagus as one swallows. During manometry, a catheter is introduced through the nose into the esophagus and pressures are measured in the esophagus and across the lower esophageal sphincter.
• Barium Swallow – An X-ray of the chest combined with a barium contrast can help determine abnormalities such as the narrowing of the oesophagus. 

Achalasia Cardia Treatment

Achalasia has no known cure. Therapy aims to help relax and dilate the esophageal sphincter, allowing food and liquid to pass into the stomach. Depending on the severity of the condition, the doctor may recommend:

Endoscopic Treatment (Non-surgical and Medical)

• Peroral Endoscopic Myotomy (POEM)- Peroral endoscopic myotomy (POEM) has shown much promise in treating patients with achalasia cardiac disease. It is less invasive than Heller myotomy and uses an endoscope to loosen the muscles in the oesophagus by cutting them
• Pneumatic Dilation - Pneumatic dilation involves the insertion of an air-filled balloon across the lower esophageal sphincter, leading to forceful dilatation of tight lower esophageal sphincter. This procedure may need to be repeated subsequently.
• Botox (Botulinum Toxin Type A) - Botox (Botulinum Toxin Type A) is a muscle relaxant when injected directly into the esophageal sphincter. This, again, is a therapy offering temporary relief.
• Medicines - Medicines may be recommended to ease the symptoms, but has temporary effects.

Surgical Treatment

• Heller Myotomy - This surgery cuts the esophageal muscles near the sphincter, allowing food to pass into the stomach. This is often done laparoscopically and is minimally invasive.

Achalasia Treatment Complications

When undergoing treatments for achalasia, patients may encounter various complications. These include:

Esophageal Perforation

One potential complication is the accidental creation of a hole in the oesophagus. This risk underscores the importance of precise and careful treatment procedures.

Incomplete Treatment and Achalasia Symptom Recurrence

Despite efforts, there's a risk of treatment not being entirely successful, leading to the return of achalasia symptoms. This highlights the need for ongoing monitoring and personalised care plans.

Gastroesophageal Reflux Disease (GERD)

Another concern post-treatment is the development or exacerbation of gastroesophageal reflux disease. Managing GERD symptoms becomes crucial in ensuring a comprehensive and effective treatment outcome.

Services offered at Max Saket 

We at Max Super Speciality Hospital are one of the few centres where state of art high resolution manometry is performed. We offer incisionless endoscopic treatment called POEM (Per oral endoscopic myotomy) for achalasia. The POEM procedure for achalasia is safe, offers excellent long-term results, and does not require extended hospital stays. After 24 hours of the POEM procedure, a liquid diet is started. At Max Hospital, Saket, our gastroenterology team, which has cumulative experience of more than 150,000 endoscopic procedures, provides cutting-edge treatment for patients with complex GI disorders. Our team, under the leadership of Dr. Vikas Singla, has one of the highest experiences in treating achalasia cardia. The team has performed more than 700 cases of per oral endoscopic myotomy in patients of achalasia cardia with excellent results. Apart from POEM , Pneumatic balloon dilatation being also performed at this institute.

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