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Achalasia Cardia

Achalasia Cardia is a rare disorder that makes it difficult for food and liquid to pass from the swallowing tube connecting your mouth and stomach (esophagus) into your stomach.

Achalasia Cardia occurs when nerves in the esophagus become damaged. As a result, the esophagus becomes paralyzed and dilated over time and eventually loses the ability to squeeze food down into the stomach. Food then collects in the esophagus, sometimes fermenting and washing back up into the mouth, which can taste bitter. Some people mistake this for gastroesophageal reflux disease (GERD). However, in achalasia the food is coming from the esophagus, whereas in GERD the material comes from the stomach.

Symptoms of Achalasia Cardia

Achalasia symptoms generally appear gradually and worsen over time. Signs and symptoms may include:

  • Inability to swallow (dysphagia), which may feel like food or drink is stuck in your throat
  • Regurgitating food or saliva
  • Heartburn
  • Belching
  • Chest pain that comes and goes
  • Coughing at night
  • Pneumonia (from aspiration of food into the lungs)
  • Weight loss
  • Vomiting
Causes of Achalasia Cardia
  • The exact cause of achalasia cardia is not known clearly. The condition may be hereditary, or it may be the result of an autoimmune disorder.
  • With this type of condition, the immune system mistakenly attacks healthy cells in the body. The degeneration of nerves in your esophagus often contributes to the advanced symptoms of Achalasia.
  • Cancer of the esophagus can cause symptoms similar to Achalasia. Another cause is a rare parasitic infection called Chagas’ disease.
Diagnosis of Achalasia Cardia —

Achalasia Cardia can be overlooked or misdiagnosed because it has symptoms similar to other digestive disorders. To test for achalasia cardia, Doctors recommend:

  • Esophageal manometry: This test measures the rhythmic muscle contractions in your esophagus when you swallow, the coordination and force exerted by the esophagus muscles, and how well your lower esophageal sphincter relaxes or opens during a swallow. This test is the most helpful when determining which type of motility problem you might have.
  • X-rays of your upper digestive system (esophagram): X-rays are taken after you drink a chalky liquid that coats and fills the inside lining of your digestive tract. The coating allows doctor to see a silhouette of your esophagus, stomach and upper intestine. You may also be asked to swallow a barium pill that can help to show a blockage of the esophagus.
  • Upper endoscopy: Gastroenterologist inserts a thin, flexible tube equipped with a light and camera (endoscope) down your throat, to examine the inside of your esophagus and stomach. Endoscopy can be used to define a partial blockage of the esophagus if your symptoms or results of a barium study indicate that possibility. Endoscopy can also be used to collect a sample of tissue (biopsy) to be tested for complications of reflux such as Barrett’s esophagus.
  • Barium Swallow: You will swallow barium prepared in liquid form. Your doctor will then track barium’s movement down your esophagus through x rays.
Treatment options available for Achalasia Cardia

Achalasia Cardia treatment focuses on relaxing or stretching open the lower esophageal sphincter so that food and liquid can move more easily through your digestive tract.

Specific treatment depends on your age, health condition and the severity of the achalasia.

Medication:  Gastroentrologist might suggest muscle relaxant before eating. These medications have limited treatment effect and severe side effects. Medications are generally considered only if you’re not a candidate for pneumatic dilation or surgery, and other medications hasn’t helped. This type of therapy is rarely indicated.

Surgical options for treating achalasia cardia include:

Heller Myotomy: The surgeon cuts the muscle at the lower end of the esophageal sphincter to allow food to pass more easily into the stomach. The procedure can be done non-invasively (Laparoscopic Heller Myotomy). Some people who have a Heller myotomy may later develop gastroesophageal reflux disease (GERD)

To avoid future problems with GERD, a procedure known as fundoplication might be performed at the same time as a Heller myotomy. In fundoplication, the surgeon wraps the top of your stomach around the lower esophagus to create an anti-reflux valve, preventing acid from coming back (GERD) into the esophagus. Fundoplication is usually done with a minimally invasive (laparoscopic) procedure.

Peroral endoscopic myotomy (POEM): In the POEM procedure, the Gastroenterologists uses an endoscope inserted through your mouth and down your throat to create an incision in the inside lining of your esophagus. Then, as in a Heller myotomy, the surgeon cuts the muscle at the lower end of the esophageal sphincter.

POEM may also be combined with or followed by later fundoplication to help prevent GERD. Some patients who have a POEM and develop GERD after the procedure are treated with daily oral medication.

Treatment Principle —
  • Udavarta Chikitsa
  • Vibandhana Oushadhas
  • Vata Gulma Chikitsa
  • Tamaka Shwasa Chikitsa
  • Mrdu Snehana protocols are adopted here.
  • Spasms can be taken as Kaphavruta Vata Avastha
  • So Kapha vata hara, anulomana , ushna, kinchit sneha drugs should be selected.

The following drugs help the lower esophageal sphincter to relax more easily —

Kashayam —
  • Lashunadi or Rasonadi Kashayam (Kapha vata haram, ushnam)
  • Gandharva Hastadi Kashayam with salt and jaggery (does anulomana)
  • Chitraka granthyadi kashayam
  • Kalashakadi Kashayam
  • Chiravilvadi kashayam
  • Nayopayam Kashayam
  • Saptasaram Kashayam
  • Panasa cada (Jack fruit leaves) , Laja (puffed rice) Kashayam with Dhanvantara gulika
Churnam —
  • Ashta Churnam
  • Bhaskara Lavana churnam
  • Hinguvachadi Churnam
  • Vaisvanara Churna
  • Avipathi Churna
Gulika —
  • Hinguvachadi Gulika
  • Antrakutara rasa
  • Dhanvantara Gulika (Muhur muhur)
  • Kasthuri Gulika
Lehyam —
  • Nayopayam lehyam
  • Dashamula haritaki
  • Parushakadi Lehyam
  • Sukumara Rasayanam
Ghritam —
  • Indukantha Ghritam (Katu tikta rasa, ushnam, sophaghanam)
  • Hapushadi Ghritam
  • Sadphala Ghrtam
  • Dadimadi Ghritam
Asavas / Arishtas —
Tailam —
  • Sukumara erandam (anulomana)
Lavanam —
  • Narikela Lavanam + Bhaskara Lavanam
External Treatment —
  • Urovasti with Lakshadi Tailam
  • Phalavarthi (Dipped in Eranda tailam should be used after food in the noon for Apana anulomana)
  • Mild sneh svedana can be given in the chest region and throat region
References —

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