Achalasia cardia is a type of neuromuscular disease of the esophagus, characterized by malfunction of the cardiac opening during swallowing, as a result - food cannot enter the stomach. Pathology is accompanied by malfunctions in the functioning of peristalsis. Experts often call this disease chiatospasm or cardiospasm.
Description
Achalasia cardia is a chronic pathology accompanied by insufficient relaxation of the lower muscle of the esophagus - the sphincter. As a result, the passage of food pieces is difficult due to the narrowing of the final section located in front of the stomach. At the same time, the sections of the esophagus that are located above expand, due to which food can return back.
This disease can develop at any age. In addition, the pathology is characterized by involuntary contraction of the muscles of the esophagus - their amplitude can be both underestimated and overestimated.
Due to such a violation, the activity and tone of the walls of the organ changes over time, which can lead to decay and food retention.
In the international classification of diseases ICD-10, achalasia of the cardia has the code K22.0.
Causes of disease
Today exactthe prerequisites for the occurrence of achalasia of the cardia of the esophagus have not yet been identified. However, modern medicine has several theories explaining the causes of the development of pathology. The main ones are:
- congenital deficiency of the nerve endings of the esophagus;
- acute deficiency of B vitamins;
- malignant neoplasms in the esophagus or stomach;
- injury to the nerve endings of the organ due to tuberculosis, as well as other viral or infectious diseases;
- damage to the nervous system that regulates the functioning of the esophagus;
- injuries of a neuropsychological nature that contribute to the disruption of cortical neurodynamics, innervation of an organ or discoordination of sphincters.
There are many more different prerequisites for the appearance of achalasia cardia, which could well explain the progression of the pathology. But these factors are still not fully understood, due to which they cannot be confirmed.
Clinical picture
Many qualified gastroenterologists believe that this pathology is a neuromuscular disease accompanied by inflammation of effectors and receptors in the autonomic nervous system.
As a result, the damaged esophagus becomes overly sensitive to hormones produced in the gastrointestinal tract. In addition, in most patients diagnosed with achalasia cardia, a decrease in the activity of cells that secrete peptides can be seen.
Symptomatics
As a rule, the disease is accompanied by signs that develop very slowly, butconstantly:
- Dysphagia. This is one of the earliest and most persistent signs of esophageal achalasia. It has some special features. Difficulties with swallowing food appear only a few seconds after it enters the esophagus. Pieces can linger inside and cause pain in the chest cavity. This symptom is accompanied by other symptoms: regular involuntary entry of food into the nasopharynx, wheezing and hoarseness during meals. Dysphagia can appear when eating any food. As the disease progresses, the symptom will slowly but steadily increase.
- Pain in the chest. This symptom occurs in more than 50% of patients. The pain is due to overflow of food in the esophagus or spasms of the smooth muscles of the organ. Usually, discomfort is localized in the interscapular space or in the chest area. In addition, pain can radiate to the neck or lower jaw.
- Weight loss. Such a phenomenon can overtake a patient at the 3-4th stage of the pathology. Despite a good appetite, the patient deliberately stops eating a lot due to ongoing pain in the chest and neck.
- Regurgitation. Sometimes a rather disgusting tasting mucus from the stomach or esophagus enters the oral cavity. In addition, there may be a taste of food eaten even a few hours ago. Especially expressive regurgitation can become after hearty snacks. Some patients experience regurgitation after resting or bending forward. By the way, this onesign is another striking symptom of achalasia cardia.
- Heartburn. Absolutely all patients face it. And it is associated with the formation of lactic acid, which occurs after the breakdown of food by enzymes.
- Symptoms of congestion. They occur due to the delay of food in the esophagus, as a result of which it gradually decomposes. The result is increased salivation, nausea, bad breath and belching.
Stages
In modern medicine, there are approximately 25 varieties of this pathology. But for greater convenience, experts combined these types into several basic degrees of achalasia of the cardia:
- intermittent disturbances in the movement of food through the esophagus, the absence of a strong expansion;
- regular disruptions in eating, impaired functioning of the lower sphincter and moderate expansion of the organ;
- cicatricial lesions of the esophagus, accompanied by its narrowing at the bottom and increase at the top;
- clear cicatricial change of the organ, its deformation and the occurrence of complications such as periesophagitis or esophagitis.
Diagnosis of achalasia cardia
The most common methods for detecting pathology:
- chest examination with X-ray;
- examination of the esophagus using an esophagoscope;
- indispensable for making a diagnosis is the method of manometry of an organ - determining its ability to contract;
- contrast radiography.
But this pathology significantly complicates the diagnosis, since its signs can be characteristic of both esophageal cancer and other malignant tumors in it. That is why, after revealing some defects in the gastrointestinal tract, a biopsy should be performed.
Another pathology that is quite capable of disguising itself as achalasia of the cardia is a narrowing of the esophagus, which is congenital or traumatic.
Often, the disease is detected already at a complicated stage, which is characterized by signs of esophagitis. It manifests itself as heaviness in the chest, burning, and bad breath. This complication of achalasia cardia is quite dangerous, as it can lead to malignant neoplasms in the digestive system.
Treatment of disease
Therapy for such a disease should be carried out with the help of medicines, conservative methods and surgical intervention. But most gastroenterologists recommend that patients undergo surgery for achalasia of the cardia.
A patient with such a diagnosis should follow a certain daily routine, while limiting himself from physical exertion. And sleep at the same time should take at least eight hours.
In addition to limiting motor activity, the patient must follow a special diet for achalasia of the cardia. First of all, it should be noted that the food taken should not be too hot, not too cold, but warm. In addition, it is very important to pay attention to the fractionala way of eating in which food must be taken in small portions, but at least 6 times throughout the day.
Many experts deservedly consider cardiodilatation as one of the most effective methods. It consists in the forced expansion of the gastric opening. Usually this manipulation is prescribed for the pathology of the first or second stage. True, cardiodilatation has a number of contraindications. That is why you should consult with a qualified specialist before prescribing this procedure.
The use of botulinum toxin is also practiced. This specific substance is introduced, in fact, into the lower esophageal sphincter and is aimed at lowering its tone. This technique is recommended, as a rule, for those patients who are contraindicated in other methods of treating achalasia of the cardia.
If we talk about drug therapy, today the most effective treatment for this pathology is the use of calcium antagonists or nitrates. These medications can significantly alleviate the symptoms of pathology, lowering their frequency and improving the overall clinical picture. In addition, such therapy is often prescribed in cases where other methods have not brought the desired effect.
Surgery
Myotomy is the most common method of surgical therapy. It is often prescribed for the reappearance of pathology. Today, this method has been improved, thanks to which it is used as a laparoscopy.
Slightly more often, specialists use a gastrostomy, with whichan artificial entrance to the gastric cavity is created. This operation is reserved for patients who cannot eat.
If none of the techniques has brought the desired result, and the patient's condition is systematically worsening, the doctor may refer him to the removal of the esophagus.
Conservative therapies
The main method of such treatment is the introduction of a miniature balloon directly into the cardia. The essence of the manipulation is to stretch the organ to completely eliminate or reduce the manifestation of symptoms. The course should be taken 4-6 times. In some cases, the procedure is rescheduled if the patient complains of a return of symptoms.
Traditional medicine
The patient must be aware that such a serious pathology cannot completely disappear only when using medical prescriptions. Any folk remedies can only act as an addition to traditional therapy, which will be prescribed by a specialist. There are several effective recipes to eliminate the unpleasant manifestations of the disease:
- Infusion based on lemongrass and ginseng root. In addition to the fact that this remedy can significantly increase the protective properties of the immune system and improve the general condition of the patient, it can tone the lower muscle of the esophagus.
- Decoction of a mixture of marshmallow, oregano and linseeds. This tool allows you to stop the inflammatory process and significantly alleviate the pain syndrome. In addition, flax has an enveloping effect, due to which the digestibility of foodrising.
- Motherwort and valerian are considered effective remedies - they allow you to get rid of nervous tension that interferes with the passage of food.
General Predictions
If the pathology was detected on time and at the same time it is not accompanied by other serious diseases, then we can talk about a favorable clinical picture. The chances of a full recovery in a patient in this condition are quite high. In addition, according to clinical studies, drug therapy brings the patient a good result and good he alth. However, the disadvantage of such treatment is long-term observation in a hospital.
The presence of fluid in the respiratory system or malignant tumors in the esophagus can worsen prognosis.
If we are talking about a disease in children, then much also depends on the presence of other pathologies in the body. But the tone of the sphincter in the esophagus of a child is much more pliable than that of an adult.
