Synonym : Achalasia of oesophagus.
What is cardiospasm?
Failure of the lower oesophageal sphincter to relax resulting in dilatation and hypertrophy of oesophagus without any demonstrable obstructive lesion.
What is the Aetiology of cardiospasm?
a) Due to spasm of cardiac sphincter
b) Functional obstruction due to achalasia, i.e. failure of relaxation. The Auerbach's plexus located between longitudinal and circular muscle is present but defective.
c) Essentially a megaoesophagus results due to a congenital abnormality
d) Associated with vitamin B deficiency and trypanosomiasis
What is the pathology of cardiospasm?
1. Oesophagus is dilated, often grossly, dilatations being most obvious in distal two-third.
2. Considerable muscular hypertrophy .
3. Mucous membrane is stretched, thinned and shows features of inflammation and sometimes ulceration.
4. Dilatation when traced downwards, narrows in a funnel shaped manner but a short distance above cardiac end, the oesophagus attains normal dimensions. Muscular movements are normal in last inch of oesophagus.
What are the clinical features of cardiospasm?
1. Age: Often female above 40
2. Long standing dysphagia with
a. Insidious onset
b) Intermittent symptoms
c) More with liquids and less with solids.
d) Patient complains of vomiting which is 'oesophageal
pseudo- vomiting', several hours after a meal.
3) Retrosternal or inter scapular discomfort.
4) Aspiration pneumonitis may be present
What special investigations are required for the diagnosis of cardiospasm?
1. Barium meal examination:
a) Pencil shaped narrowing of lower segment of oesophagus. Enormous dilatation of oesophagus with smooth termination of barium meal.
b) Absence of gas bubble in stomach
c) Inco-ordinated peristalsis of oesophagus
1) Grossly dilated lower oesophagus
2) Cardiac orifice difficult to see due to spasm
Medical : Drugs such as probanthine
a) Intermittent dilatation Operative (20%)
with oesophageal bougies a) Fundoplication
b) Continuous dilatation with b) Heller's cardiomyotomy
Plummer's hydrostatic bag