Achalasia Cardia

• Mode of treatment for achalasia is associated with high rate of recurrence : Botulinum toxin.
• Progressive Dysphagia,Regurgitant vomitting  is a presenting problem.
• Dilated and Tortuous Esophagus is seen in Achalasia Cardia.
• The cause is degeneration of ganglion cells of auerbach’s myenteric plexus.
• Treatment includes heller’s cardiomyotomy, forceful dilation by pneumatic balloon, repeated injection botulinum toxins and drugs improving motility of esophagus.
• Esophagectomy is not a treatment modality for achalasia cardia.
• Barium swallow shows a dilated esophagus with tapering narrowing in the terminal end of esophagus, described as ‘BIRD BEAK’ appearance.
• Fluoroscopy shows loss of normal peristalsis in the lower third of the esophagus..
• Dysphagia equal for both solid and liquid from the very onset suggests motor disorder i.e achalasia and diffuse esophageal spasm.
• The characteristic esophageal manometry finding in achalasia cardia is Impaired lower esophageal sphincter relaxation and absent peristalsis.
• It is believed that cause of ganglion cell degeneration in achalasia is an autoimmune process attributable to a latent infection with human herpes simplex virus 1 combined with genetic susceptibility.
• The malignancy which is a close mimicker of achalasia is Carcinoma of gastric fundus.
• The most sensitive diagnostic evaluation for achalasia cardia is Esophageal Manometry.

The pharmacologic agents used in Achalasia are:

1. Nitrates
   
2. Calcium channel blockers
   
3. Botulinum toxin
   
4. Sildenafil- phosphodiesterase inhibitors, effectively decrease LES pressure.

• In pneumatic dilatation for the treatment of achalasia, the cylindrical balloon dilator is dilated upto 3-4 cm.
• Achalasia is associated with increased risk of Squamous Cell carcinoma of Esophagus.
• Uniform dilation of esophagus is seen in Achalasia Cardia.
• Elevated resting LES tone is seen in Achalasia.
• A 40-year-old female patient presented with dysphagia to both liquids and solids and regurgitation for 3 months. The dysphagia was non-progressive.Achalasia cardia is the most likely diagnosis.
• ‘Pencil tip’ deformity is seen in Achalasia Cardia.
• Heller’s operation treatment of choice in Achalasia Cardia.
• Radiologic feature suggestive of Achalasia cardia is?   Absence of gastric air bubble  , Air fluid level in mediastinum  ,Sigmoid esophagus.
• Maximum dilatation of esophagus occurs in Achalasia Cardia.
• Amyl nitrite inhalation is used to distinguish patients of achalasia from those with pseudoachalasia.
• Non visualization of gastric fundic bubble with air-fluid level in retrocardiac region suggests Achalasia Cardia.