Introduction

Achalasia Cardia is a medical condition that affects the esophagus, the muscular tube that carries food and liquids from the mouth to the stomach. In people with achalasia, the muscles of the esophagus fail to relax properly, making it difficult to swallow and often causing chest pain and regurgitation. Although rare, achalasia can significantly affect quality of life.

Understanding Achalasia Cardia

Achalasia is characterized by two main problems: the lower esophageal sphincter (LES) does not relax properly during swallowing, and the esophagus lacks normal peristalsis (wave-like muscle contractions). While the exact cause remains unknown, it is likely linked to nerve damage affecting esophageal muscle control.

Common Symptoms

• Dysphagia: Difficulty swallowing both solids and liquids.
• Regurgitation: Food or liquids returning to the mouth after swallowing.
• Chest Pain: Especially behind the breastbone, sometimes after eating.
• Heartburn: Burning sensation due to acid reflux.
• Weight Loss: Caused by difficulty eating and poor nutrition.

Diagnosis

Diagnosing achalasia usually involves the following:

• Barium Swallow: X-ray after swallowing contrast liquid to observe esophageal function.
• Esophageal Manometry: Measures muscle pressure and coordination in the esophagus.
• Endoscopy: A camera scope used to examine the esophagus and rule out other conditions.

Treatment Options

Although there is no permanent cure, various treatments can help manage symptoms and improve swallowing.

• Medications: Calcium channel blockers or nitrates to relax the LES.
• Botulinum Toxin Injection: Temporarily relaxes the LES by blocking nerve signals.
• Pneumatic Dilation: Balloon-based widening of the LES.
• Surgery: Heller’s Cardiomyotomy is the preferred surgical option for long-term relief.

Understanding Heller’s Cardiomyotomy

Heller’s Cardiomyotomy is a surgical procedure designed to relieve symptoms by cutting the muscle fibers of the LES, allowing easier passage of food into the stomach.

• Preparation: Includes preoperative imaging, labs, and anesthesia assessment.
• Anesthesia: Performed under general anesthesia.
• Procedure: A small abdominal incision is made, and the LES muscles are cut without damaging the inner lining of the esophagus.
• Closure: Surgical incisions are closed with sutures or staples.

Recovery and Postoperative Care

• Pain Management: Mild to moderate pain is expected and can be controlled with medications.
• Dietary Adjustments: Start with liquids and progress slowly to soft, then solid foods.
• Activity: Avoid heavy lifting or strenuous activity for several weeks.
• Follow-Up: Necessary to ensure proper healing and assess surgical success.

Risks and Complications

• Infection at the surgical site
• Bleeding during or after surgery
• Gastroesophageal reflux (GERD)
• Accidental perforation of the esophagus or stomach (rare)