The most severe pains (esophagodynic crises) are observed without food during excitement, physical exertion, at night and are explained by extra-swallowing contractions of the esophagus. Such crises can last from several minutes to an hour and occur at different intervals (from daily to once a month).
In this case, fluid intake or food intake can help. At stage IV of achalasia cardia, pain almost disappears or fades into the background, giving way to increasing dysphagia and regurgitation. Almost all patients gradually lose weight, weaken, lose their ability to work. The disease proceeds in waves, with exacerbations and remissions. Despite the benign nature of the disease, with untimely treatment of AK, such terrible complications as bleeding, perforation of accutane pills wall (perforation), inflammation of the mediastinum, and general exhaustion can develop. In some cases, esophageal cancer develops against the background of AK.
The diagnosis of achalasia of the cardia is established on the basis of the data of the patient's survey, the characteristic signs of the disease, as well as the data of the instrumental study. X-ray examinations are of decisive importance. First, an overview picture of the chest is taken and if a shadow of the dilated esophagus is visible on it with the presence of a liquid level in it, then a picture is taken with a preliminary ingestion of a contrast agent (barium sulfate). The main radiological sign of AK is the narrowing of the end of the esophagus with clear, even contours and the expansion of the esophagus, located above the narrowing.
To determine the presence and degree of decrease in the tone of the cardiac sphincter, esophagotonokymography (manometry) is performed - registration of pressure in the esophagus and peristalsis during swallowing with special cartridges. This method provides important information about the condition of the muscles of the esophagus and the lower esophageal (cardiac) sphincter. Treatment and prevention of achalasia cardia.
X-ray of a patient with achalasia of the cardia. The diagnosis is also confirmed by endoscopic examination - esophagoscopy, in which the doctor can examine the mucous membrane of the esophagus using an endoscope.
Treatment of achalasia cardia is to improve the patency of the cardiac sphincter. There are two main methods of treatment - balloon dilatation of the cardia and surgical treatment, which consists in dissecting the muscles. Recently, botulinum toxin administration has been used to treat achalasia. Drug therapy is of an auxiliary nature and is not used independently in the treatment. Consider the pros and cons of different methods of treating achalasia cardia.
To date, balloon dilatation of the cardiac sphincter has become the most common in the treatment of achalasia. The undoubted advantage of such treatment is low trauma, no need for anesthesia, a small number of complications (rupture of the esophagus). But this method of treatment of achalasia cardia has its drawbacks. First, the mechanism of intervention itself. In fact, during dilatation, a rupture of the cardiac sphincter occurs with the formation of cracks in the esophageal mucosa and inflammation.
Secondly, the problem of non-disclosure of the cardia is eliminated, but instead another problem of non-closure of the cardiac sphincter is created, which often leads to the development of reflux esophagitis. And finally, with balloon dilatation, a recurrence of Accutane of the cardia often occurs, and cicatricial strictures of the cardiac sphincter are often formed. In addition, such treatment is often effective only for grades 1 and 2 of achalasia.
Recently, the administration of botulinum toxin into the cardiac sphincter has become widespread. In this case, paralysis of the sphincter muscles occurs and it opens. The main disadvantages of this technique for the treatment of cardia achalasia are a temporary effect (from 6 to 12 months) and the development of reflux esophagitis.
