achalasia of the cardia
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failure of normal relaxation of the lower esophageal sphincter associated with uncoordinated contractions of the thoracic esophagus, resulting in functional obstruction and difficulty swallowing.
achalasiaA dysmotility disorder characterised by a loss of peristalsis in the distal 2⁄3 of the oesophagus accompanied by impaired relaxation of the lower oesophageal sphincter.
Idiopathic, possibly autoimmune; secondary to neoplasia, vagotomy, sarcoid, MEN2A.
Dysphagia, chest pain, vomiting, heartburn.
Plain films, air-fluid level in enlarged oesophagus, barium swallow, bird’s beak tapering and, if prolonged, sigmoid oesophagus.
Chaga’s disease, T-cruzi amastigotes.
Pneumatic dilation of oesophagus; medication (e.g., nitroglycerin, CCBs (e.g., nifedipine); surgery (e.g., Heller myotomy). Short-term (maximum 12-month) response is achieved with intrasphincteric injection of botulinum toxin.