Achalasia cardia - a chronic disease of the neuromuscular system of the esophagus, characterized by impaired reflex opening of the lower esophageal sphincter at the entrance to the stomach during swallowing. This is accompanied by a violation, and peristaltic movements of the esophagus. As a result, difficult passage of food into the stomach.
Causes of achalasia cardia has not been fully established. It is believed that achalasia cardia arises from the mismatch of neural regulatory mechanisms responsible for the peristaltic movements of the esophagus and the disclosure of a reflex of the lower sphincter is approached him bolus. Some researchers believe that the occurrence of the disease play an important role of malnutrition, especially lack of intake of vitamin B
Achalasia cardia occurs in patients of any age and develop gradually. The patient is concerned about regurgitation just eaten food with no signs of digestion. There are pains. Pain can be the first sign of illness. The nature of their very diverse: from diffuse chest pain patients to accurately indicates the place. Pain may be given in the shoulder, neck, shoulder, ear, etc. Pain after eating there, but often the pain may be independent of food intake. Over time, the pain decreases. The patient may complain of a sense of delayed receipt of food in the stomach. Some people just show delays of food on the front surface of the chest.
Most patients use a variety of ways to facilitate the penetration of food into the stomach: a drink in one gulp large amounts of fluid, tilted, or reject the body, hold hands around the neck or behind the breastbone. Regurgitation or regurgitation at first appears immediately after a meal, and then gradually, due to the expansion of the lower esophagus there is an increasing amount of stored food. This food has burps later. But in this case just regurgitates a lot of food. This condition is sometimes referred to as esophageal vomiting. In contrast to the usual vomiting, vomit food mass are chewed food with no signs of digestion in the stomach. Regurgitation of food may cause reflux of the bolus into the trachea and then into the lungs. There are inflammatory lung disease, aspiration pneumonia. Sometimes a patient having complaints of persistent hiccups. Achalasia cardia is often accompanied by constipation.
There are four stages of achalasia cardia:
The initial stage or the stage of functional intermittent spasm. The narrowing of the lower esophageal sphincter (cardia) and the expansion of the esophagus above the cardium are missing. Difficulty swallowing food occur periodically.
This phase is stable. In this case, there comes a constant (stable) spasm of the cardia. Cardium of the esophagus is slightly enlarged. Complaints about the patient become permanent.
In the third stage of cicatricial changes occur in the tissue of the lower esophageal sphincter. Subjected to hardening of the sphincter loses its elasticity and can not be fully disclosed. Esophagus above the sphincter rapidly expanding.
The fourth stage - a stage of complications. Stenosis (narrowing) of the cardia expressed sharply. Cardium of the esophagus is enlarged considerably. Inflammation occur in the wall of the esophagus (esophagitis), necrotic ulcers on the walls of the esophagus. Inflammation can spread to surrounding tissue. There is inflammation of the mediastinum - mediastenit.
Diagnosis of achalasia cardia by means of X-ray methods. On radiographs show a level of fluid in the enlarged esophagus, changes in the lungs. With the help of a contrast study (barium passage) - note the delay of contrast medium in the esophagus, extension of the esophagus. With esophagogastroscopy make inspection of the walls of the esophagus and esophageal cancer, and exclude other diseases. Complication of achalasia cardia may be the depletion of the patient, and in the case of long-term illness increases the risk of esophageal cancer processes.
Treatment of achalasia cardia
For the treatment of achalasia cardia is used endoscopic balloon dilatation (expansion) of the lower openings of the esophagus (the cardia). In the lumen of the lower esophageal sphincter introduce an endoscope with a special balloon, which is then inflated and expands cardia. In most cases, this method is effective, but in some cases, the procedure must be repeated. If this method fails, surgery was performed.