ACHALASIA CARDIA
ACHALASIA CARDIA
Achalasia cardia is a rare disorder of the esophagus where there is impaired relaxation of LES with swallowing and impaired ability of the esophagus to push food down into the stomach. This occurs due to damage to nerves present in the wall of esophagus.
Signs and Symptoms:
- Dysphagia (difficulty in swallowing)
- Chest pain
- Regurgitation of food
- Vomiting
- Hiccups
- Halitosis(foul smelling breath)
- Weight loss
- Stridor
Complications:
Complications may include malnutrition, dehydration, weight loss and aspiration pneumonia
DIAGNOSIS:
- Barium swallow (X-ray with a contrast material)
- Esophageal manometry
- Intraluminal impedance testing
- Upper GI Endoscopy
Treatment:
Non-surgical treatment:
Pneumatic balloon dilation: It involves widening and loosening of the LES using a balloon to enlarge the narrowed area. Patients may however need repeated sittings.
Medical therapy:Medicines help in reducing LES pressure to allow food to enter stomach in early stage of disease. Medicines used are smooth muscle relaxants such as nitrates and calcium channel blockers.
Botulinum toxin injection: this muscle relaxant is directly injected into the LES. Patients may however, need repeat injections.
Endoscopic treatment:
Per Oral endoscopic Myotomy(POEM):
The endoscope is passed through mouth. Saline is injected in the wall of esophagus to create a space along the region of muscular layer. The endoscope is then passed into this region and the non-relaxing muscles are endoscopically cut. The advantage of POEM is we can take cut into any length of muscular layer as required.
Surgical treatment:
Laparoscopic Heller’s myotomy:
A tube like lens system (laparoscope) is passed into abdomen through a key-hole incision, to reach the esophagogastricjunctionfrom outside. The affected muscles are cut. The limitation of this approach is that we cannot cut the esophageal muscle that lies higher up in the chest wall. Hence in certain types of Achalasia, Laparoscopic myotomy may not be completely effective.
AT ANTRANG WE HAVE SO FAR DONE 23 POEM PROCEDURES SUCCESSFULLY!!!
Diagnostic Indications & Treatment
- Symptoms
- Complications
- Treatment
- Dysphagia (difficulty in swallowing)
- Chest pain
- Regurgitation of food
- Vomiting
- Hiccups
- Halitosis(foul smelling breath)
- Weight loss
- Stridor
Complications may include malnutrition, dehydration, weight loss and aspiration pneumonia
Non-surgical treatment:
Pneumatic balloon dilation: It involves widening and loosening of the LES using a balloon to enlarge the narrowed area. Patients may however need repeated sittings.
Medical therapy:Medicines help in reducing LES pressure to allow food to enter stomach in early stage of disease. Medicines used are smooth muscle relaxants such as nitrates and calcium channel blockers.
Botulinum toxin injection: this muscle relaxant is directly injected into the LES. Patients may however, need repeat injections.
Endoscopic treatment:
Per Oral endoscopic Myotomy(POEM):
The endoscope is passed through mouth. Saline is injected in the wall of esophagus to create a space along the region of muscular layer. The endoscope is then passed into this region and the non-relaxing muscles are endoscopically cut. The advantage of POEM is we can take cut into any length of muscular layer as required.
Surgical treatment:
Laparoscopic Heller’s myotomy:
A tube like lens system (laparoscope) is passed into abdomen through a key-hole incision, to reach the esophagogastricjunctionfrom outside. The affected muscles are cut. The limitation of this approach is that we cannot cut the esophageal muscle that lies higher up in the chest wall. Hence in certain types of Achalasia, Laparoscopic myotomy may not be completely effective.
AT ANTRANG WE HAVE SO FAR DONE 23 POEM PROCEDURES SUCCESSFULLY!!!
A TIPPS Procedure was done at Kolhapur which gave patient immediate relief. This kind of procedure is done for the first time ever in this region.
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