Achalasia Cardia: A Guide Including Causes and Exploring Treatment Options

Achalasia cardia, also known as cardiospasm, is an oesophageal dynamic disorder caused by nerve damage in the food tube (oesophagus). In this condition, the oesophagus is stopped from sending food to the stomach. Cardiospasms can occur due to an abnormal immune system response. The disorder can take a serious turn if it goes unchecked, leading to the development of oesophageal cancer. However, identifying the symptoms at the initial stage and getting the necessary treatment can reduce the risk of achalasia cardia.

What Causes Achalasia?

Cardiospasm is a rare health condition, and the exact cause is unclear. However, researchers suspect that the causes of esophageal achalasia are likely to be triggered by a virus. Achalasia cardia damages the nerve cells in the muscle layers of the oesophagus walls and the lower oesophageal sphincter (LES). The nerve cells which control muscle functions are disrupted over time for unknown causes. This leads to excessive contractions in the LES. The disease is caused when LES fails to relax, preventing foods and liquids from passing through the oesophagus into the stomach. It is also suspected that a rare occurrence of achalasia cardia may be inherited. Unfortunately, there is not much evidence to support these theories.

What Are the Primary Symptoms of Achalasia Cardia?

Achalasia cardia symptoms develop slowly, and some of them stay for months or even years (in some cases). These symptoms include:

• The most common symptom of cardiospasm is trouble swallowing (dysphagia)
• Coughing at night
• Regurgitation of undigested foods 
• Heartburn
• On and off chest pains
• Malnutrition/weight loss is due to difficulty eating. This symptom comes late. 
• Difficulty belching, hiccups (these are rare symptoms)

How Is Achalasia Cardia Diagnosed?

To diagnose achalasia cardia, a healthcare provider may conduct the following tests:

Upper Endoscopy

In this test, a thin tube attached to a camera, known as an endoscope, is inserted down the oesophagus. The camera displays images of the inside of your oesophagus on a screen for the test. This test helps rule out carcinogenic (malignant) lesions and detects achalasia.

Manometry

This test examines the time and intensity of the oesophageal contractions and the relaxation of the LES. The disorder is detected when LES fails to rest in response to swallowing, and there are no muscular contractions along the oesophageal walls.

Barium Swallow

This test involves swallowing a barium solution (liquid or any other form) and evaluating its travel down the oesophagus with X-rays. The barium swallow will reveal a narrowing of the oesophagus at the LES.

How Is Achalasia Treated?

Achalasia cardia treatment involves relaxing or extending the LES, allowing foods and liquids to pass through the digestive tract smoothly. There are specific treatments for achalasia, depending on the age, health condition, and seriousness.

OnabotulinumtoxinA (Botox)

It is a muscle relaxant injected inside the oesophageal sphincter using a needle during endoscopy. The injections may need to be repeated, which can complicate future surgery processes (if required).

Pneumatic Dilation

During this clinic operation, a balloon is placed into the centre of the LES and inflated to widen the aperture. If the oesophageal sphincter doesn’t remain open, the process may be repeated. When this procedure is conducted, patients are normally sedated.

Medicine

Medical providers may recommend that you take muscle relaxants like nifedipine and nitro-glycerine before eating. The treatment effect of such relaxants is limited, and doctors advise them only when other treatments fail to work.

What Are the Complications of Treatments for Achalasia?

Some complications arise from achalasia cardia due to food backing up (regurgitating) into the oesophagus and being dragged into (aspirated) your trachea (windpipe), which goes to your lungs. The complications include:

• Pulmonary infections
• Pneumonia
• Oesophageal cancer

Conclusion

Though the symptoms of achalasia cardia seem similar to those of other digestive disorders, the common cause is suspected to be damage to nerve cells responsible for muscle contractions in the LES. This prevents food and liquids from passing through the digestive tract, leading to several complications. Doctors prescribe various treatments to support the relaxing of the oesophageal sphincter.