Achalasia cardia is a condition wherein the lower oesophageal sphincter fails to relax.

1. Achalasia Cardia
synonym : Cardiospasm
Lavina Belayutham

2. Definition
1.‘Achalasia’ is a Greek term that means "does
not relax’.
2. It is a primary oesophageal motility disorder
associated with the spasm of the lower
oesophageal sphincter due to neuromuscular
incoordination characterised by:
a) spasm of the cardiac end of the oesophagus
b) dilatation of the lower two thirds of the
oesophagus

4. Etiology
Hurst :
Degeneration of the Auerback’s plexus leading to failure
of relaxation of the cardiac orifice.
Jackson :
Abnormal pinch-cock action by the right crus of the
diaphragm.
-Aerophagia may be one cause of the dilated oesophagus.
-Principal lesion is the denervation of the oesophageal
smooth muscles.
-Trypanosoma cruzi of the myenteric plexus may be
associated with megaoesophagus ( Chaga’s disease)

5. Symptoms
1. Affects both male and female
2. Insidious in onset
3. Retrosternal or epigastric fullness following
meals is the main symptom
4. Dysphagia is a late symptom( more to liquids
than solids)
5. Regurgitation of swallowed food (especially
at night)
6. Loss of weight

6. Signs
- Pooling of saliva may be seen on indirect
laryngoscopy and may be associated with
reflux laryngitis.

7. Diagnosis
1. Radiography (barium swallow)
- Fusiform dilatation of the oesophagus with
fluid level
- ‘Pencil-tip’ or ‘bird’s beak’ smooth filling
defect of the cardiac end of oesophagus
- Hurst phenomenon : Barium gets into the
stomach like snow flakes.
- Loss of fundal gas shadow.

9. 2. Manometric studies
- low pressure at the body of the oesophagus
and high pressure at the lower sphincter with
failure of the sphincter to relax
3. Endoscopy
- To exclude benign strictures or development
of carcinoma

10. Treatment
1.Medical :
- Smooth muscle relaxants like isosorbide
dinitrite,and calcium channel blockers like
diltiazem,nifedipine and verapamil have been
tried.

11. 2.Surgical:
-Modified Heller’s operation (myotomy of the
narrowed lower portion of the oesophagus )
-Balloon dilatation or dilatation with hydrostatic
bag or ‘Hurst-mercury’ boogies/
-Botulinum toxin type A injection (to relax the
lower oesophageal sphincter)
-Anastomosis between the stomach and
oesophagus may be necessary if the
oesophagus is grossly lengthened or kinked.