Cardiac achalasia is a neuromuscular pathology of the esophagus, which is associated with changes in esophageal peristalsis and tone.
Cardiac department performs the function of muscle pulp. It relaxes while the food moves into the stomach and closes to prevent the contents from being thrown back into the esophagus.
The special functioning of the muscles is regulated by the autonomic nervous system. When the vegetative regulation changes, there is a violation of its synchronous work. Because of this, food stays longer in the esophagus, stretching its walls. The result is an increase in the lumen.
The concept of
This is an ailment that is characterized by the lack or lack of relaxation of the esophageal sphincter. Because of this, there is a constant violation of the passage of the esophagus. Disorders are expressed in chaotic contractions of smooth muscles. Their amplitude can be reduced or increased.
The ICD-10 code is K22.0.
Reasons for the emergence of
There are a huge number of theories trying to establish the prerequisites for the development of the disease.
Some scientists associate pathology with a defect in the nerve plexuses of the esophagus, secondary injuries of nerve fibers, infectious diseases, a deficiency in the body of vitamin B.
There is also a theory according to which the development of the disease is associated with a violation of the central regulation of the functions of the esophagus. In this case, the disease is considered as a neuropsychic trauma, which led to a disorder of cortical neurodynamics and other pathological changes.
It is believed that at the very beginning the process is reversible, but eventually develops into a chronic disease.
There is one more opinion, according to which the development of the disease is associated with chronic inflammatory diseases, which affect the lungs, radical lymph nodes, neuritis of the vagus nerve.
Classification of Achalasia of the Esophagus Cardiology
There are more than 25 different classifications of this disease. One of the most convenient for physicians is the division of the disease into stages:
- In the first stage, functional spasm is noted, but narrowing of the cardia and expansion of the esophagus are absent.
- In the second stage, the number of cases of spasms increases. There is an uneven expansion of the esophagus.
- At the third stage, cicatricial changes are formed in the muscle layers of the department. There is a pronounced expansion of the body.
- In the fourth stage, marked stenosis and significant changes in the esophagus are noted. There is a stagnant esophagitis with areas of dead tissue and ulceration.
There is a division of the disease and by type. At the heart are radiographic signs. There are two main types:
- The first is characterized by a moderate narrowing of the esophagus. His circular muscles are in a state of hypertrophy and dystrophy.59% of all cases fall on this type.
- In the second type, there is a significant narrowing of the distal esophagus. Its membrane changes its structure and is supplemented by interlayers of connective tissue. The body can take the form of the letter S.
The first type can go into the second. Sometimes doctors talk about intermediate forms.
Symptoms of
For cardiac achalasia, the following are characteristic:
- chest pain,
- weight loss,
- dysphagia.
The latter is expressed in the violation of food ingestion. It arises from the slowing down of the passage of a man's stomach. The features of this process are as follows:
- The passage is broken not immediately, but 3-4 seconds after the start of ingestion.
- At first, a sensation of obstruction arises in the chest area.
- Thus liquid food passes worse, than firm.
As a result of disturbance of natural swallowing processes, food can get into the nasopharynx, trochea. This is a prerequisite hoarseness of voice, perspiration in the throat.
Another symptom is involuntary leakage of food through the mouth. This phenomenon is more often detected when eating a lot of food, as well as when torso is tilted. Emerging pains in the chest are bursting or spastic. They are associated with stretching the walls of the esophagus.
Features of the disease in children
Children often develop an ailment after five years. In rare cases, doctors speak of congenital diseases. During the infancy, vomiting is marked with breast-milk undigested. Regurgitation occurs when the baby sleeps, there is a night cough. Children of older age are concerned about pain, especially in the thoracic region.
These children are more often infected with bronchitis and pneumonia. When studying an anamnesis, doctors often find out that such babies eat more slowly, chew their food. Chronic disorders can lead to developmental lag and anemia.
Complications of
The main complications include the appearance of severe narrowing of the scars of the cardia department. In rare cases, the mucous membrane is malignantly degenerated. Aspiration of pneumonia occurs. This is due to the ingress of food pieces into the person's airways.
All this is supplemented by inflammatory processes and exhaustion of the body. The latter is due to the minimal intake of nutrients in the body. Due to irregularities in the work of the organs, adhesions and ulcers may occur.
Differential diagnosis of
In the formulation of an accurate diagnosis, problems with differentiation of achalasia, esophageal cancer, and cardia are more common.
An x-ray examination reveals asymmetric narrowing and uneven contours. There is a violation of the mucosal relief and rigidity of the wall.
Esophagoscopy with biopsy plays a decisive role. The material is taken for histological and cytological examination.
The main indicator for radiologic symptoms is narrowing of the terminal section of the esophagus. It is expanded, becoming longer and more twisted. When esophagoscopy reveals thickened folds of the mucous membrane and areas of hyperemia, the appearance of erosion.
Often a symptom is a disorder in the functioning of the esophagus. To damage the diagnosis or in case of cardia deficiency, pharmacological methods of manometry are used. The latter allows to assess the state of the sphincter and musculature in the lower part of the esophageal tube.
Treatment of Achalasia Cardia
The most common treatment methods are the use of medications and surgery. Drug treatment is used only in the early stages of the disease.
In this case, the treatment has peculiarities, because the drugs patients can not always successfully swallow. If this function is violated, the medications are prescribed so that they can be dissolved under the tongue or put in the form of injections.
This therapy is aimed at suppressing symptoms, but drug treatment is effective only in 10% of cases. Usually, this effect is prescribed for the elderly, who are contraindicated in surgical care.
The main group of medicines is represented by medicines aimed at relaxing the esophagus. These include:
- Isosorbide,
- Dinitrate,
- Nitroglycerin.
This effect is supplemented by myotropic antispasmodics. The method of treatment and dosage are prescribed depending on the stage of the disease and form, taking into account individual characteristics. Sedative medications relax the muscles of the larynx.
Surgical treatment of
The most popular method is balloon dilatation. This is an endoscopic method of treatment, which is based on mechanical rupture of the fibers of the lower esophageal sphincter.
Despite the fact that there are different manufacturers of cylinders their design is the same for all. The device is a balloon catheter with a channel for the conductor, through which the installation in the area of the lower sphincter. All manipulations take place under the radiological control.
The conductor carries a balloon. This manipulation has only one serious complication - perforation of the esophagus.
Forecast and Prevention
Cardiac Achalasia is a slowly progressive disease. Lack of timely treatment can lead to bleeding, violations of the integrity of the walls of the esophagus and general exhaustion of the body.
After the treatment, there may be a relapse in 6-12 months. Good prognostic results are observed in the absence of irreversible changes in esophageal motility.
Preventive measures consist in elimination of various risk factors which can become preconditions for occurrence of disease. Experts recommend to give up smoking and alcohol, avoid overstrain and stress.
After the disease, various procedures are prescribed to reduce the risk of relapse.
A prerequisite is compliance with the diet. The daily ration should be divided into 5 meals, which must be thoroughly chewed. After eating, it is recommended to take a few vigorous sips of water or tea.
Video about achalasia of esophageal cardia: