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Achalasia affects the esophagus, the tube that carries swallowed food from the back of the throat down into the stomach. A ring of muscle called the lower esophageal sphincter encircles the esophagus just above the entrance to the stomach. This sphincter muscle is normally contracted to close the esophagus. When the sphincter is closed, the contents of the stomach cannot flow back into the esophagus. Backward flow of stomach contents (reflux) can irritate and inflame the esophagus, causing symptoms such as heartburn. The act of swallowing causes a wave of esophageal contraction called peristalsis. Peristalsis pushes food along the esophagus. Normally, peristalsis causes the esophageal sphincter to relax and allow food into the stomach. In achalasia, which means "failure to relax," the esophageal sphincter remains contracted. Normal peristalsis is interrupted and food cannot enter the stomach.
Causes of achalasia cardia or cardiospasm
Though thew actual cause of achalasia cardia is not known exactly, but there are some theories postulated for the aetiology of achalasia cardia of oesophagus.
- The motor nerve supplying oesophagus is vagus nerve which control the movement. It is assumed that any vagal disturbance may be a cause of achalasia cardia or cardiospasm.
- The pinch- cock action of diaphragmatic cruras may be responsible as it may lead to dilatation of lower end of esophagus.
- Aurebach,s myenteric plexus is a bunch of nerves supplying the oesophagus and degeneration of this aurebach,s plexus my lead to dilatation of esophagus causing achalasia cardia.
- Many persons having a habit of mouth breathing may suffer from achalasia thus it is assumed that air swallowing may have a role in causing cardiospasm or achalasia cardia.
- Hirschprung's disease or megacolon is a congenital gastrointestinal disease and achalaisa cardia may be due to primary dilatation like the same disease.
- Lack of integrated parasympathetic stimulation and non propulsive motility of the esophagus may lead to dilatation of the esophagus causing achalasia cardia.
The first-line treatment for achalasia is balloon dilation. In this procedure, an inflatable membrane or balloon is passed down the esophagus to the sphincter and inflated to force the sphincter open. Dilation is effective in about 70% of patients.
Three other treatments are used for achalasia when balloon dilation is inappropriate or unacceptable.
- Botulinum toxin injection
Injected into the sphincter, botulinum toxin paralyzes the muscle and allows it to relax. Symptoms usually return within one to two years.
This surgical procedure cuts the sphincter muscle to allow the esophagus to open. Esophagomyotomy is becoming more popular with the development of techniques allowing very small abdominal incisions.
- Drug therapy
Nifedipine, a calcium-channel blocker, reduces muscle contraction. Taken daily, this drug provides relief for about two-thirds of patients for as long as two years.
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