Achalasia of the Cardia (Cardiospasm, Achalasia of the Esophagus, Megaesophagus, Idiopathic Dilatation of the Esophagus, etc.)

Achalasia of the cardia is a chronic neuromuscular disease of the esophagus, which is characterized by impaired reflex opening of the cardia during swallowing, impaired peristalsis and decreased tone of the thoracic esophagus. This is a rare disease, the etiology of which is not well understood. It has been suggested that viral infection, genetic predisposition and psychological trauma may be risk factors for the development of achalasia.

The pathogenesis of esophageal achalasia is associated with disruption of the activity of the intramural neuromuscular apparatus of the esophagus caused by a deficiency of the neurotransmitter nitric oxide. Impaired relaxation of the lower esophageal sphincter leads to the fact that it opens only under the mechanical influence of food accumulated in the esophagus.

Symptoms of achalasia cardia include chest pain, difficulty swallowing (dysphagia), and esophageal vomiting (regurgitation). Substernal pain manifests itself in the form of pain crises, often occurring at night. Dysphagia is initially episodic, but in severe cases it is observed with every meal and worsens with excitement. Regurgitation is manifested by regurgitation of saliva, mucus and food debris accumulated in the esophagus.

To confirm the diagnosis of Cardia achalasia, an x-ray examination is performed, which reveals varying degrees of dilation and lengthening of the esophagus, impaired peristalsis and accumulation of fluid in the esophagus on an empty stomach. The cardial segment of the esophagus is narrowed, has smooth contours and the appearance of a “carrot tip” or “mouse tail”; it does not open when swallowing, delaying the flow of contrast into the stomach.

The most effective treatment for achalasia cardia is endoscopic dilatation of the cardia. When spastic contractions of the distal part of the esophagus resume, calcium antagonists and prolonged nitrates are used, with atony of the thoracic part of the esophagus - irokinetics, and with concomitant esophagitis - enveloping agents. If repeated endoscopic dilations are ineffective, surgical treatment is performed - cardiotomy.

The prognosis of Cardia achalasia depends on the severity of the disease and the effectiveness of treatment. Timely and correct treatment can significantly improve the patient's quality of life and prevent the development of complications such as aspiration pneumonia, megaesophagus and esophageal cancer. However, in some cases, despite treatment, relapses and progression of the disease may occur. Therefore, it is important to regularly monitor the patient's condition and provide the necessary treatment as needed.