Question

Achalasia cardia.

Hint:

Early diagnosis and treatment of achalasia can prevent complications like malnutrition and aspiration pneumonia.

Answer 1

Step 1: Understanding Achalasia Cardia.
Achalasia cardia is a rare disorder of the esophagus, characterized by the inability of the lower esophageal sphincter (LES) to relax properly and the absence of coordinated peristalsis in the esophageal body. This results in difficulty swallowing (dysphagi, regurgitation of food, and, in some cases, chest pain.

Step 2: Pathophysiology.
The primary pathophysiologic mechanism involves degeneration of the myenteric plexus (Auerbach’s plexus), which causes a loss of the ability to coordinate muscle contractions in the esophagus. The LES fails to relax properly after swallowing, leading to a functional obstruction.

Step 3: Diagnosis and Symptoms.
Common symptoms of achalasia include:

Dysphagia: Difficulty swallowing both solids and liquids.
Regurgitation: Undigested food may come back into the mouth.
Chest pain: May mimic angina.
Weight loss: Due to difficulty eating and swallowing.

Step 4: Treatment.
Treatment options include:

Pneumatic dilation: A balloon is used to dilate the LES.
Surgical myotomy: The muscles of the LES are surgically cut to allow for better passage of food.
Pharmacologic treatment: Medications such as nitrates or calcium channel blockers can help relax the LES.

Step 5: Conclusion.
Achalasia is a chronic condition that can significantly impair quality of life, but with proper treatment, symptoms can be alleviated, and patients can lead normal lives.