Questions on Achalasia cardia
- Inflammation and loss of inhibitory neurons in Auerbach's plexus which secrete VIP and Nitric oxide
- Aperistalsis in the body of esophagus due to neuritis and ganglionitis followed by fibrosis of neurons
Wallerian degenerative changes have been described in the vagus nerve and dorsal motor nucleus of the vagus,
- Progressive esophageal dilatation
- Mucosal changes in the form of ulceration and fibrotic thickening
- Muscle hypertrophy also occurs
- Genetic association with Allgrove's syndrome
- HLA based- HLA DQw1 HLA DQB1
- Immune Association with Rheumatoid Arthriris and endocrinopathies
- Viral- HSV, polio.
Vigorous achalasia is defined as the presence of nonpropulsive contractions with an amplitude greater than 37 mm Hg.
Complications of Achalasia Surgery
- Persistent Dysphagia- Inadequate myotomy
The study done to find out completeness of Myotomy is timed barium study. A timed barium study compares the height of a barium column in the esophagus at 1 and 5 minutes after the patient drinks 250 cc of liquid barium within 45 seconds. In most patients who have untreated achalasia there is minimal (5%–10%) emptying over this time period . After successful myotomy there commonly is complete (90%–100%) emptying by the 5-minute film.
- Site of myotomy
The best location for a myotomy would seem to be on the left side of the esophagus extending down across the angle of His onto the fundus of the stomach. A myotomy in this location would disrupt the longitudinal and circular muscular fibers of the esophagus as well as the oblique gastric fibers while preserving the clasp fibers along the lesser curve side of the stomach.
- Post myotomy stricture or scarring
Inadequate separation of muscle fibres
- Post op leak
- Post op GERD