DOI: http://dx.doi.org/10.18203/2349-2902.isj20194086

A case report on achalasia cardia type - II

Sadiya Mustafavi, Atif Abdul Samee, Shafia Siddiqui, Tanveer Yousra

Abstract


Achalasia cardia is the rare chronic neurodegenerative disorder of the esophagus which causes progressive delay in contractility of lower esophageal muscles during swallowing leading to backup of food contents and fluids in later stages within the region of esophagus. It is considered as the common leading cause of motor dysphagia. The underlying etiology include autoimmune disorder, nervous degeneration due to loss of inhibitory ganglion in myenteric plexus of esophagus, presence of inhibitory neurotransmitters such as nitric oxide and its receptors in lower esophagus. At initial presentation drugs are prescribed as the symptoms mimic other GI disorders which often lead to delayed diagnosis. The symptoms mainly include severe pain or discomfort of chest after eating, weight loss, regurgitation of bland undigested food or saliva, severe heartburn, dysphagia, aspiration. Initial treatment includes the pharmacotherapeutic management to alleviate the symptoms and improve the esophageal outflow. Surgical treatment involves pneumatic dilatation, Heller’s myotomy, preoral endoscopic myotomy, esophagectomy. Heller’s myotomy may be performed by open or laparoscopic procedure. It is done along with Dor’s fundoplication. Case report discussed below is of a 55 years old female patient presented with dysphagia for one year. The symptoms of which worsened for 2 months along with vomiting of undigested foul-smelling food.


Keywords


Achalasia cardia, Motor dysphagia, Neurodegenerative disorder, Pharmacotherapeutic management, Esophageal motor disorders

Full Text:

PDF

References


O'Neill OM, Johnston BT, Coleman HG. Achalasia: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013;19(35):5806–12.

Uptodate. Achalasia: Pathogenesis, clinical manifestations, and diagnosis. Available at: https://www.uptodate.com/contents/achalasia-pathogenesis-clinical-manifestations-and-diagnosis?csi=259df577-ca76-47bb-95d5-89d9a760aa19&source=contentShare#H21885408

Eckardt VF, Köhne U, Junginger T, Westermeier T. Risk factors for diagnostic delay in achalasia. Dig Dis Sci. 1997;42(3):580-5.

Ghoshal UC, Daschakraborty SB, Singh R. Pathogenesis of achalasia cardia. World J Gastroenterol. 2012;18(24):3050–57.

Singh P, Terrell JM. Antacids. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019.

Shin JM, Sachs G. Pharmacology of proton pump inhibitors. Curr Gastroenterol Rep. 2008;10(6):528–34.

Bortolotti M, Labò G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology. 1981;80(1):39-44.

National Center for Biotechnology Information. PubChem Database. Isosorbide dinitrate, CID=6883, Available at: https://pubchem.ncbi. nlm.nih.gov/compound/6883. Accessed on 07 April 2019.

Eherer AJ, Schwetz I, Hammer HF, Petnehazy T, Scheidl SJ, Weber K, et al. Effect of sildenafil on oesophageal motor function in healthy subjects and patients with oesophageal motor disorders. Gut. 2002;50:758-64.

Paterson WG, Goyal RK, Habib FI. Esophageal motility disorders. Gimo. 2006.

Mittal RK, Goyal RK. Sphincter mechanisms at the lower end of the esophagus. Gimo, 2006.

Arora Z, Thota PN, Sanaka MR. Achalasia: current therapeutic options. Ther Adv Chronic Dis. 2017;8(6-7):101–8.

Chuah SK, Chiu CH, Tai WC, Lee JH, Lu HI, Changchien CS, et al. Current status in the treatment options for esophageal achalasia. World J Gastroenterol. 2013;19(33):5421–9.

Pohl D, Tutuian R. Achalasia: an overview of diagnosis and treatment. J Gastrointestin Liver Dis. 2007;16:297–303.

Kurian AA, Bhayani N, Sharata A, Reavis K, Dunst CM, Swanström LL. Partial anterior vs partial posterior fundoplication following transabdominal esophagocardiomyotomy for achalasia of the esophagus: meta-regression of objective postoperative gastroesophageal reflux and dysphagia. JAMA Surg. 2013;148:85–90.

Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240(3):405-12.

Torquati A, Richards WO, Holzman MD, Sharp KW. Laparoscopic Myotomy for Achalasia. Ann Surg. 2006;243(5):587–93.

Glatz SM, Richardson JD. Esophagectomy for end stage achalasia. J Gastrointest Surg. 2007;11(9):1134-7.

Mari A, Patel K, Mahamid M, Khoury T, Pesce M. Achalasia: Insights into Diagnostic and Therapeutic Advances for an Ancient Disease. Rambam Maimonides Med J. 2019;10(1).

Sadowski DC, Ackah F, Jiang B, Svenson LW. Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil. 2010;22(9).

Dawn L. Francis, David A. Katzka. Achalasia: Update on the Disease and Its Treatment. Gastroenterology. 2010;139(2):369-74.

Jung DH, Park H. Is Gastroesophageal Reflux Disease and Achalasia Coincident or Not? J Neurogastroenterol Motil. 2017;23(1):5-8.

Xiang H, Han J, Ridley WE, Ridley LJ. Bird's beak sign: Achalasia. J Med Imaging Radiat Oncol. 2018;62(Suppl 1):58.

Patel DA, Lappas BM, Vaezi MF. An Overview of Achalasia and Its Subtypes. Gastroenterol Hepatol (N Y). 2017;13(7):411-21.

Chuah SK, Wu KL, Hu TH, Tai WC, Changchien CS. Endoscope-guided pneumatic dilation for treatment of esophageal achalasia. World J Gastroenterol. 2010;16(4):411-7.