Specialist ENT CARDIOSPASM

CARDIOSPASM

Synonym: Achalasia of oesophagus.

Definition: Failure of the lower oesophageal sphincter to relax resulting in dilatation and hypertrophy of oesophagus without any demonstrable obstructive lesion.

Specialist ENT Screenshot 2020 11 30 book oesophagus almost final4

Aetiology:

Theories

  1. Due to spasm of cardiac sphincter.
  2. Functional obstruction due to achalasia, i.e. failure of relaxation. The Auerbach’s plexus located between longitudinal and circular muscle is present but defective.
  3. Congenital abnormality like megaoesophagus.
  4. Associated with vitamin B deficiency and trypanosomiasis (Chaga’s disease).

Pathology:

  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.

Clinical features:

  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.
Special investigations: 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.

Specialist ENT Screenshot 2020 11 30 book oesophagus almost final5
2) Oesophagoscopy:(Rigid or Flexiable)
  1. Grossly dilated lower oesophagus.
  2. Cardiac orifice difficult to see due to spasm.

Treatment:

Medical: Drugs such as probanthine.

Specialist ENT Screenshot 2020 11 30 book oesophagus almost final6
Specialist ENT Screenshot 2020 11 30 book oesophagus almost final7
Specialist ENT Screenshot 2020 11 30 book oesophagus almost final8

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