achalasia of the cardia


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e·soph·a·ge·al a·cha·la·si·a

failure of normal relaxation of the lower esophageal sphincter associated with uncoordinated contractions of the thoracic esophagus, resulting in functional obstruction and difficulty swallowing.

achalasia

A 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.

Aetiology
Idiopathic, possibly autoimmune; secondary to neoplasia, vagotomy, sarcoid, MEN2A.

Clinical findings
Dysphagia, chest pain, vomiting, heartburn.
 
Imaging
Plain films, air-fluid level in enlarged oesophagus, barium swallow, bird’s beak tapering and, if prolonged, sigmoid oesophagus.
 
DiffDx
Chaga’s disease, T-cruzi amastigotes.

Management
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.

e·soph·a·ge·al a·cha·la·si·a

(ĕ-sof'ă-jē'ăl ak'ă-lā'zē-ă)
An obstruction to the passage of food that develops in the terminal esophagus; caused by an autonomic nervous system abnormality.
Synonym(s): achalasia of the cardia, cardiospasm, oesophageal achalasia.

achalasia of the cardia

Inability of the lower end of the gullet (oesophagus) to relax, because of spasm. The cause is unknown. There may be regurgitation of food, inhalation of swallowed material, with pneumonia and severe loss of weight. The condition is sometimes complicated by cancer of the oesophagus. Also known as cardiospasm.