Achalasia Cardia

Achalasia of the cardia (cardiospasm, chiatic spasm, megaeo-phagus, idiopathic esophagus expansion, etc.) -a disease is relatively rare, characterized by dystrophic changes in the intramural nerve plexus of the esophagus and cardia, atony, esophagus dilatation, disruption of peristalsis of its wall and reflex opening of the cardia upon swallowing, and As a result of this, a violation of the passage of food into the stomach and a prolonged delay in the esophagus.

Etiology and pathogenesis are not well understood.

Symptoms, course. The chest pain, dysphagia and regurgitation are characteristic. Chest pain manifests itself in the form of painful crises, often occurring at night; Sometimes pain occurs when an empty or, conversely, overcrowded esophagus. Dysphagia at first episodic, in severe cases is observed with each meal and especially when ingesting a dry or poorly chewed food, increases with excitement. To facilitate the passage of food, patients drink a glass of water with a volley or swallow the air, take deep breaths, arch the trunk back, etc., which in some cases helps. Regurgitation is manifested by regurgitation of the saliva, mucus and food residues that accumulate in the esophagus, arising when the body tilts, with a crowded esophagus or at night, during sleep. In the latter case, aspiration of regurgitated masses is possible, which is often the cause of aspiration pneumonia.

The diagnosis is confirmed by X-ray examination, which shows a varying degree of expansion and lengthening of the esophagus, in some cases combined with its S-shaped curvature, disruption of peristalsis, accumulation in the esophagus of fluid on an empty stomach. Barium suspension is prolonged in the esophagus, its upper level often reaches the level of the clavicles, after which it suddenly "falls" into the stomach. The cardial segment of the esophagus is narrow, has smooth contours and the appearance of the "carrot tip" or "mouse tail," does not open when swallowed, delaying the flow of contrast into the stomach; Gas bubble of the stomach is absent (pathognomonic sign). Taking 1-2 tablets of nitroglycerin relaxes the cardiac sphincter, so that the contents of the esophagus pass easier into the stomach and temporarily eliminate dysphagia. This pharmacological test facilitates the differential diagnosis of achalazine cardia and organic esophageal stenosis. Esophagogastrofibroscopy helps in the differential diagnosis of these diseases.

The course is usually progressive with increased dysphagia and other symptoms of the disease, increasing exhaustion. Complications: repeated aspiration pneumonia and chronic bronchitis. A more frequent occurrence of esophageal cancer in these patients was noted.

Treatment. Drug therapy is ineffective. Treatment is most often performed by cardiodilation (using a metal or pneumatic cardiovascular) in special therapeutic or surgical hospitals, where this technique is established. With a significant expansion and lengthening of the esophagus, an extrasyllabic esophagocardiomyotomy is performed, supplemented with esophagocardiofio-reno or gastroplasty. With a particularly sharp expansion of the esophagus, the operation is also supplemented by esophagodization (suturing of the enlarged part) and the reduction of its terminal part into the abdominal part.

The prognosis for timely treatment is favorable. Patients are contraindicated in the work associated with heavy physical exertion and irregular eating habits.