Achalasia Cardia is a congenital abnormality of oesophagus which is characterized by
Aperistalsis, Partial or incompleate relaxation of lower oesophageal sphincter, increase resting tone of lower oesophageal sphincter.

Clinical Feature
Dysphagia - Difficulty in swallowing more to lequid.
Retro Starnal pain
Regurgitation of Food.
Foetid Flatulence.
Loss of weight.

Treatment
1. Ca channel antagonist eg- nifedipine.
2. Ballon Dialation.
3. Heller's Operation.- cutting of muscle of lower oesophageal sphincter.

Achalasia cardia is a pathological condition characterized by failure of relaxation of distal oesophagus and oesophagogastric junction. It could be primary in which there is absence of ganglion cells in the myenteric plexus or it could be secondary as seen in Chaga’s disease where there is progressive degeneration of ganglion cells. Usually the patients affected are middle aged females, however, the lesion can be seen occasionally in children. The cause of achalasia is unknown but the entity is also reported to occur in families.

Achalasia cardia can be treated in one of three ways:

a. by balloon dilatation: 75% effective; some chances of recurrence; quite safe, you can go home the same day or the next.

b. by open surgery: 95% effective, fewer chances of recurrence, slightly safer than balloon dilatation, but the effects of surgery will keep you at home for 2-4 weeks.

c. by laparoscopic surgery: more than 90% effective, nearly as effective and nearly as safe as open surgery. You can go home in a day or two.

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Achalasia Cardia is primarily a disease of esophagus in which lower end of esophagus (Lower Esophageal Sphincter-LES) does not relax properly in response to food intake and there is inappropriate and ineffective motility (Peristalsis) of the body of esophagus. This leads to impaired emptying of esophagus and gradual dilatation of this tubular structure. There is thickening of lower end along with increase in fibrous tissue in muscular layer of esophagus.

IMGhttp://i430.photobucket.com/albums/qq28/kevinbernard31/Achalasiacardia.jpg/IMG

This normally happens between the age of 20-50 yrs and involves both males and females equally.

Symptoms:

Mostly patient complains of gradually increasing difficulty in swallowing food (both solids and liquids). There is feeling of stickiness in throat.
These symptoms tend to increase whenever there is stress or cold.
Undigested food tends to come back into mouth (Regurgitation).
Chest infections / pneumonia tend to occur due to aspiration of food into windpipe.
Heartburn / acidity sensation
Severe chest pain in 30-40% of patients

Diagnosis:

Barium meal (Esophagogram)- ?Bird?s Beak? is the typical presentation in which there is tapering of lower end of esophagus after massively dilated middle part of it. Air-Fluid levels are seen in the middle part of esophagus. Image intensifier (Fluoroscopic) evaluation suggest improper motility ( peristaltic ) activity.

Endoscopy Upper GI- Undigested food particles along with ingested fluid filled esophagus. Lower end of esophagus fail to open even after air insufflation.

Manometry- considered the gold standard in the diagnosis of this disease. There is failure of relaxation of lower end of esophagus. Pressure at lower end may be high but it may be normal also.

Endoscopic Ultrasound- Thickened muscle layers in the lower part of esophagus.

Treatment:

Treatment is by surgical dilation of the oesophagus.
Laparoscopic cardiomyotomy for Achalasia Cardia.
http://openmed.nic.in/1668/