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You are sitting to enjoy your favourite meal, only to find that swallowing feels like a difficult task. For patients with achalasia cardia, this is not a one-time problem; rather, the patient lives with the condition every day. Achalasia cardia is a disorder that turns the simple act of eating into a frustrating situation.
But what actually is achalasia cardia? Let’s know.
Achalasia cardia is a rare disorder of the esophagus where the myenteric nerve plexus of the esophageal wall deteriorates and loses its functional activity, causing deranged esophageal peristalsis. More specifically, it hinders the ability of the lower esophageal sphincter (LES) to relax and allow food into the stomach. As a result, the acidic contents of the stomach come back into the esophagus, leading to acid reflux.
Patients with achalasia struggle with swallowing food. They even suffer from regurgitation of food, chest pain and weight loss.
Achalasia cardia treatment is essential to get relief from the symptoms and prevent further complications. But for accurate diagnosis and cure, understanding its types is also crucial.
In the blog, we have broken down the three types of achalasia cardia, how they differ from each other and the treatment options.
The symptoms of achalasia cardia develop slowly and last for months or years. Some of the common warning signs include the following:
It is important to know that chest pain, regurgitation of undigestible food and heartburn are also symptoms of GERD (Gastroesophageal reflux disorder). However, the two conditions are completely different. Hence, make sure to consult an expert for a proper evaluation, as misdiagnosis can worsen the condition.
The malfunction of muscles in achalasia cardia varies. Hence, based on the problems, the condition is divided into three categories.
It is also known as “classic achalasia”. The condition is characterised by a minimal or complete absence of peristalsis (muscle contractions) and the failure of the LES to relax. With this type, the food moves down due to gravity alone rather than muscle movement. If achalasia cardia treatment is ignored, the progression of Type 1 is quite serious and quick.
Type II achalasia is very common and responsive to treatment. In this type, the symptoms are mild, but they worsen over time. Here, pressure builds up throughout the esophagus, causing it to become compressed. The LES still fails to relax, but the esophagus still retains some ability to pass down the food.
Type III achalasia is sometimes called spastic achalasia and is the most difficult to treat. The condition is characterised by abnormal contractions at the bottom of the esophagus where it meets the stomach. As compared to Type I and Type II, this type results in excessive muscle contractions, causing severe chest pain that feels like a heart attack.
If achalasia cardia treatment is delayed, it can cause serious complications. Gradually, patients experience trouble in eating and swallowing, which ultimately results in malnutrition and weight loss. Moreover, if the condition is present for a long time, it can even lead to esophageal cancer, particularly squamous cell carcinoma.
Esophageal cancer has a poor prognosis, with a generally low survival rate. Hence, make sure to get timely treatment to manage the symptoms effectively and prevent serious outcomes.
The exact cause is still not known. However, experts believed that the following risk factors could be the reason behind its development and the necessity of achalasia cardia treatment.
Genetic factors: Genetic predisposition increases the risk of achalasia cardia. If you have a family history of the condition, there is a high chance that you will inherit the disease.
Autoimmune disorders: Some research suggests that sometimes the body’s immune system mistakenly attacks the nerve cells of the esophagus. Patients with achalasia are likely to have conditions such as uveitis, type I diabetes, rheumatoid arthritis, systemic lupus erythematosus and Sjögren’s syndrome.
Viral infection: Infections by viruses like the herpes simplex virus are considered triggers for achalasia cardia.
Loss of nerve function: Nerve degeneration in the esophageal wall prevents the LES from relaxing, interfering with the way it should work.
Achalasia cardia is usually suspected in individuals with difficulty swallowing both solid and liquid foods, along with other symptoms like regurgitation of undigested food. The common diagnostic procedures include the following:
There are no permanent treatment options. The condition can only be managed. Based on the results of the examinations, your doctor will employ these achalasia cardia treatment modalities.
Pharmacotherapy: It involves the use of medicines like long-acting nitrates and calcium channel blockers. The clinical response of this method is the least effective, and there are side effects of the medicines.
Botox injections: It involves injecting a maximum of 100 units of botulinum toxin using a sclero-needle close to the squamo–columnar junction. The technique is useful for patients who cannot tolerate invasive procedures.
Pneumatic Dilation: It is an endoscopic procedure that includes using a balloon to widen the LES muscle fibres.
Surgery: Laparoscopic Heller Myotomy is the standard procedure. It is minimally invasive and involves small incisions to cut off the muscle fibres at the junction of the oesophagus and stomach to open the LES.
Esophagectomy: It is done in the advanced stage, where patients become unresponsive to conventional treatments. Here, all or part of the esophagus is removed.
Achalasia cardia does not affect every individual in the same way. The difference in Type I, II, and III affects the achalasia cardia treatment options. With the right approach, it is possible to manage the condition and feel better.