Achalasia of the cardia is a type of neuromuscular disease of the esophagus, characterized by a violation of the cardiac opening during swallowing, as a result - food cannot enter the stomach. Pathology is accompanied by malfunctions in the functioning of peristalsis. Specialists often call this disease hiatospasm or cardiospasm.
Description
Achalasia of the cardia is a chronic pathology, accompanied by insufficient relaxation of the lower muscle of the esophagus - the sphincter. As a result, patency of food slices is hindered by narrowing of the final section located in front of the stomach. In this case, the sections of the esophagus located above expand, due to which food can come back.
Such a disease can develop at any age. In addition, the pathology is characterized by involuntary contraction of the muscles of the esophagus - their amplitude can be either underestimated or overestimated.
Due to such a violation, the activity and tone of the walls of the organ change over time, which can lead to rot and food retention.
In the international classification of diseases ICD-10, achalasia of the cardia has the code K22.0.
Causes of the disease
Today, the exact prerequisites for the occurrence of achalasia of the cardia of the esophagus have not yet been identified. However, modern medicine has several theories that explain the causes of the development of pathology. The main ones are:
- congenital deficiency of the nerve endings of the esophagus;
- acute shortage of B vitamins;
- malignant neoplasms in the esophagus or stomach;
- trauma to the nerve endings of an organ due to tuberculosis, as well as other viral or infectious diseases;
- damage to the nervous system that regulates the functioning of the esophagus;
- injuries of a neuro-psychological nature, contributing to the violation of cortical neurodynamics, innervation of the organ or discoordination of the sphincters.
There are many more different prerequisites for the appearance of achalasia of the cardia, which could well explain the progression of pathology. But these factors are still not fully understood, due to which they cannot be confirmed.
Clinical picture
Many qualified gastroenterologists believe that this pathology is a neuromuscular disease, accompanied by inflammation of effectors and receptors in the autonomic nervous system.
As a result, a damaged esophagus becomes overly sensitive to hormones produced in the gastrointestinal tract. In addition, in most patients diagnosed with cardiac achalasia, a decrease in the activity of peptide-secreting cells can be seen.
Symptomatology
As a rule, the disease is accompanied by signs that develop very slowly, but constantly:
- Dysphagia. This is one of the earliest and most permanent signs of achalasia of the cardia of the esophagus. It has some features. Difficulties with swallowing food appear only a few seconds after it penetrates the esophagus. The pieces may linger inside and cause pain in the chest cavity. Other symptoms are accompanied by this symptom: regular involuntary ingestion of food in the nasopharynx, wheezing and hoarseness during meals. Dysphagia is able to appear with the use of any dishes. Together with the progression of the disease, the symptom will slowly but constantly intensify.
- Chest pain. This symptom is manifested in more than 50% of patients. The pain is due to overflow of food in the esophagus or spasms of the smooth muscles of the organ. Usually, discomfort is localized in the interscapular space or in the chest area. In addition, pain can be given to the neck or lower jaw.
- Weight reduction. Such a phenomenon can overtake a patient at the 3-4th stage of pathology. Despite a good appetite, the patient intentionally ceases to eat a lot due to persistent pain in the chest and neck.
- Regurgitation. Sometimes, a rather disgusting taste of mucus from the stomach or esophagus enters the oral cavity. In addition, there may be a taste of food eaten even a few hours ago. Especially expressive regurgitation can become after hearty snacks. Some patients have regurgitation after resting or leaning forward. By the way, this particular sign is another striking symptom of achalasia of the cardia.
- Heartburn. Absolutely all patients face it. And it is associated with the formation of lactic acid, which occurs after the breakdown of food by enzymes.
- Symptoms of stagnation. They arise due to the delay in food in the esophagus, as a result of which it gradually decomposes. As a result, there is an increased separation of saliva, nausea, an unpleasant odor from the oral cavity and belching.
Stages
In modern medicine, there are approximately 25 varieties of this pathology. But for greater convenience, experts combined these types into several basic degrees of achalasia of the cardia:
- intermittent disturbances in the movement of food along the esophagus, the absence of strong expansion;
- regular interruptions in food intake, impaired functioning of the lower sphincter and moderate expansion of the organ;
- cicatricial damage to the esophagus, accompanied by its narrowing at the bottom and an increase from above;
- pronounced cicatricial change in the organ, its deformation and the occurrence of complications as periesophagitis or esophagitis.
Diagnosis of achalasia of the cardia
The most common methods for detecting pathology:
- chest examination with an x-ray;
- examination of the esophagus using an esophagoscope;
- indispensable for making a diagnosis is the method of organ manometry - determining its ability to contract;
- contrast radiography.
But this pathology significantly complicates the diagnosis, since its symptoms can be characteristic of both cancer of the esophagus and other malignant formations in it. That is why, after identifying any defects in the gastrointestinal tract, a biopsy should be performed.
Another pathology that is quite capable of disguising as achalasia of the cardia is a narrowing of the esophagus, which is congenital or traumatic.
Often, the disease is detected already at a complicated stage, which is characterized by signs of esophagitis. It manifests itself as a heaviness in the chest, burning sensation, as well as bad breath. This complication of achalasia of the cardia is quite dangerous, since it can lead to malignant neoplasms in the digestive system.
Disease treatment
Therapy for such a disease should be carried out with the help of medications, conservative methods and surgical intervention. But most gastroenterologists recommend that patients undergo surgery with achalasia of the cardia.
A patient with such a diagnosis should follow a certain daily routine, while limiting himself from physical exertion. And sleep should take at least eight hours.
In addition to limiting motor activity, the patient must follow a special diet for cardiac achalasia. First of all, it should be borne in mind that the food taken should not be too hot, not too cold, but warm. In addition, it is very important to pay attention to the fractional way of eating, in which food must be taken in small portions, but at least 6 times a day.
Many experts deservedly consider cardiodilation one of the most effective methods. It consists in the forced expansion of the gastric opening. Usually this manipulation is prescribed for pathology of the first or second stage. True, cardiodilation has a number of contraindications. That is why, before appointing this procedure, you should consult with a qualified specialist.
The use of botulism toxin is also practiced. This specific substance is introduced, in fact, into the lower sphincter of the esophagus and is aimed at lowering its tone. This technique is recommended, as a rule, to those patients who are contraindicated in other methods of treatment of cardia achalasia.
If we talk about drug therapy, today the use of calcium or nitrate antagonists is considered the most effective treatment for this pathology. These medications can significantly alleviate the symptoms of pathology, lowering their frequency and improving the overall clinical picture. In addition, such therapy is often prescribed in cases where other methods have not brought the desired effect.
Surgical intervention
Myotomy is the most common surgical treatment technique. It is often prescribed for the reappearance of pathology. Today, this method has been improved, due to which it is used as laparoscopy.
More often, specialists use a gastrostomy, with the help of which an artificial entrance to the gastric cavity is created. Such an operation is prescribed to patients who can not eat.
If no technique has brought the necessary result, and the patient’s condition is systematically worsening, the doctor can direct him to remove the esophagus.
Conservative Therapies
The main method of such treatment is the introduction of a miniature balloon directly into the cardia. The essence of the manipulation is to stretch the organ to completely eliminate or reduce the manifestation of symptoms. The course should be taken 4-6 times. In some cases, the procedure is prescribed again if the patient complains about the return of symptoms.
ethnoscience
The patient should be aware that such a serious pathology cannot completely disappear solely when using medical prescriptions. Any folk remedies can only act as an addition to the traditional therapy, which the specialist will prescribe. There are several effective recipes to eliminate the unpleasant manifestations of the disease:
- Infusion based on lemongrass and ginseng root. In addition to the fact that this tool can significantly increase the protective properties of the immune system and improve the general condition of the patient, it can tone the lower muscle of the esophagus.
- A decoction of a mixture of marshmallow, oregano and flaxseed. This tool allows you to suspend the inflammatory process and significantly alleviate the pain syndrome. In addition, flax has an enveloping effect, due to which the digestibility of food increases.
- Motherwort and valerian are considered an effective remedy - they allow you to get rid of nervous tension that interferes with the passage of food.
General forecasts
If the pathology was detected on time and at the same time it is not accompanied by other serious diseases, then we can talk about a favorable clinical picture. The chances of a full recovery in a patient in this condition are quite high. In addition, according to clinical trials, drug therapy brings the patient a good result and good health. However, the long-term observation in stationary conditions is considered a minus of such treatment.
Predictions can worsen the presence of fluid or malignant tumors in the esophagus in the respiratory system.
If we are talking about a disease in children, then much depends on the presence of other pathologies in the body. But the tone of the sphincter in the esophagus of a child is much more supple than that of an adult.