What is Achalasia Cardia?
Achalasia cardia, simply referred to as achalasia means ‘failure to relax’
It is a rare motility disorder which affects the esophagus (the tube that carries swallowed food from the throat down into the stomach)
What happens in Achalasia cardia?
During swallowing, there is a wave of esophageal contraction called peristalsis (Esophageal motility), which pushes the food down the esophagus, into the stomach. A ring of muscle fibres encircle the lower end of esophagus - Lower esophageal sphincter (LES). Normally, while swallowing, LES relaxes to allow the food into the stomach.
In achalasia, the normal esophageal peristalsis and the lower esophageal sphincter (LES) relaxation, both are impaired
What causes and how common is achalasia cardia?
Etiology remains unknown, but pathology is due to loss of nerve cells within the distal esophagus and LES.
Achalasia is a rare disorder affecting 0.03 to 1.63 per 100,000 persons per year and 1.8 to 12.6 per 100,000 persons per year
What are the symptoms of Achalasia? Do I have Achalasia?
Achalasia patients complain of
· Difficulty in swallowing, sensation of food or water getting stuck in the chest
· Chest pain (which can sometimes be mistaken for heart attack)
· Regurgitation of food and
· Weight loss
How is achalasia diagnosed? What is Esophageal manometry?
Diagnosis of achalasia is based on diligent medical history and excluding other medical conditions that may mimic achalasia. Endoscopy can be normal in achalasia. However, endoscopy can detect tumors of the esophagus which can present with similar symptoms as achalasia.
Esophageal manometry is a procedure done to confirm the diagnosis of achalasia. Manometry helps in diagnosing esophageal motility disorders. It is done by passing a thin probe through the esophagus, to assess the strength/pattern of esophageal persistaltic wave progression and lower esophageal sphincter (LES) relaxation during swallowing.
In achalasia, (LES) is too tight, and the goal of treatment is to weaken the LES.
What are the risks/ complications of achalasia cardia?
· Achalasia can lead to decreased quality of life, poor nutrition and damage to the esophagus.
· Patients with long standing achalasia can have complications of megaesophagus and squamous cell carcinoma
What is POEM (Per Oral endoscopic myotomy)?
In POEM procedure, a small incision is made in the innermost layer of the esophagus (the mucosa). Endoscopic tunnel is made down the remaining length of the esophagus in the layer called the submucosa. In the lower esophagus, we cut the muscle fibers of the lower esophageal sphincter and the incision made in the mucosa is closed using clips
Should I undergo POEM? How safe is POEM?
Per Oral endoscopic myotomy (POEM) is an incisionless endoscopic procedure/ surgery done for the treatment of achalasia. POEM procedure has excellent long term results compared to other modalities of treatment (Pneumatic balloon dilatation and laproscopic Hellers Myotomy). POEM is a safe and does not require long hospital stay post procedure. We use endoscopy rather than conventional surgery, which involves an incision in the skin
Who does POEM for Achalasia in Delhi?
Currently only a few gastroenterologists are trained and experts in performing POEM procedure in Delhi. Gastroenterologists need to be specially trained in advanced endoscopy and third space endoscopy to perform a complex procedure like POEM.
Dr Surakshith T K, Consultant gastroenterologist and Hepatologist at Fortis Escorts Hospital, New Delhi. Expertise in advanced endoscopic procedures & third space endoscopy - POEM for achalasia cardia (>75 procedures), ESD/EMR for early cancer, ERCP and EUS (endoscopic ultrasound). He also an expert in manomtery and GI motility studies
For more information about Achalasia or to consult with expert gastroenterologist - contact
Dr Surakshith T K
Consultant gastroenterologist
Fortis Escorts Okhla road, New Delhi
www.drsurakshithtk.com, +919686137977
Clinic:
Kalka Superspecialty Clinic
10/22, Nehru place road, Nehru Enclave East, Kalkaji, New Delhi -110019
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