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Achalasia Cardiae

Achalasia is a motility disorder of the oesophagus, where there is a nerve degeneration in the Auerbach´s plexus, causing inability of the lower oesophageal sphincter in the cardia region (C) to relax. In oesophageal x-ray examanations a dilatation of the oesophagus is seen, and the contrast stays in the oesophagus for a long time. Endoscopy is important in order to exclude other causes of dysphagia. Endoscopic examination often shows a quite normal cardia, and in less severe cases the endoscopic diagnose is not easy. A constant spasm just above the cardia region can be visualized but the passage of the endoscope into the stomach is usually not difficult.

These pictures are from a patient with dysphagia for about two years, causing a weight loss of over 40 pounds. In advanced cases (which this is not), the dilatation of the oesophagus is quite marked.

One year later, when the symtom where somewhat relieved by dilatations, the oesophagus is still slightly dilated.

Chagas´disease is an important differential diagnosis. This disease is caused by an infection with Trypanosoma cruzi and in this disease, the symtoms and x-ray findings are identical with classic achalasia. Chagas´disease is common in some countries in Latin America.

Still one year later, the symtoms has worsened, and the patient is still losing weight. These pictures show a seriously dilated oesophagus with a very slow transit through the cardia region. The picture to the left is taken in a standing position, in the picture to the right the patient is lying down. In endoscopy, the oesophagus is filled with food in an advanced case like this. A situation like this could be treated by repeated dilatations or by surgical laparoscopic cardiomyotomy.

Oesophagus just above the cardia in a patient with achalasia. This image are taken during inspection of this region for several minutes.

Here are some books about this topic if You need more information:

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April 7, 2007