Achalasia Cardia :- √ Causes :- A - Auerbach's Myentric Plexus Degeneration B - Vitamin B 1 Deficiency C - Chaga's Disease ( T. Cruzi ) S - Diffuse Oesophageal Spasm S - Stress S - Squamous Cell Carcinoma Risk S - Shape ( Pencil Shaped Narrowing Of Oesophagus - Corkskrew Oesophagus ) √ Pathology :- 1. Thickening Of Circular Muscle Fibres In Distal Oesophagus. 2. Myentric Inflammation - Depletion Of Ganglion Cells - Neural Fibrosis - Reduced Nitrous Oxide And Vasoactive Intestinal Peptide. 3. Absence Of Peristalsis - Increased LES Pressure - Failure Of Relaxation With Functional Obstruction Of Oesogastric Junction. 4. Dilatation Of Proximal Oesophagus With Atony. Clinical Features :- • Females - MC • Early Stage - Chest Pain • Vigorous Achlasia • Heart Burn • Malnutrition • Odynophagia • Walking while eating, chin thrusting, neck and shoulder extension And Valsalva Manoeuvre - Emptying Of Contents From Oesophagus. • Lung Abscess Formation • Recurrent Pneumonia Triad :- • Progressive Dysphagia - Liquid > Solid • Regurgitation • Weight Loss Investigations :- • Oesophageal Manometry - Gold Standard - Shows unrelaxed oesophageal sphincter with high resting pressure. • Oesophagoscopy - Rule out oesophagus carcinoma. Biopsy of mucosa at LES should be done. • Chest X-Ray - Shows patches of pneumonia. • Barium Swallow - Diagnostic 1. Bird Beak Appearance ( Smooth Narrowing Of Lower Oesophagus ) . 2. Dilatation Of Proximal Oesophagus. 3. Absence Of Fundic Gas. 4. Sigmoid Oesophagus Or Mega Oesophagus.
