Cardiospasm

Achalasia means inability to relax. Cardiospasm means spasm of cardiac sphincter of the oesophagus. This article is suitable for junior health professionals.

 

I shall describe a case:

 

CJ, 65M

Admitted with :

Dysphagia – few months

Vomiting few months

Wt loss few stones

PMH - GU HLO +ve 2003

Looks well

? Benign peptic stricture

 

CXR in achalasia cardia

 

Straight left heart border

Double right heart border upper part

Absent fundal gas?(in retrospect)

Extra dense shadow behind the heart

 

Barium swallow X-ray first. (to avoid the risk perforation with OGD first).

 

Barium swallow in Achalasia cardia

 

Tight tapering stricture lower oesophagus

Dilated upper oeso with food residue

No peristalsis

The transition zone is smooth & tapered, not shouldered.

 

OGD is also done to rule out malignancy.

 

Diagnosis – Achalasia cardia

 

Treatment of achalasia

Endoscopic balloon dilatation

Botox injection

Heller’s operation – cardiomyotomy - laparoscopically