A lady presents to you with complaints of dysphagia to both solids and liquids along with episodes of intermittent chest pain. Barium swallow done in her shows a dilated lower esophagus. What is the best modality of treatment in her?
This patient is suffering from achalasia cardia an esophageal motility disorder caused by the loss of ganglion cells withing esophageal myentric plexus. Best method of treatment in her would be Heller's myotomy usually done along with paial fundoplication. Achalasia: Clinical features: Patients often presents with dysphagia, chest pain, regurgitation and weight loss. Investigations: Barium swallow shows a dilated esophagus with poor emptying, an air fluid level and tapering at LES giving a bird beak appearence. Esophageal manometry shows impaired LES relaxation and absent peristalsis. Management : Pharmacologic therapy: Drugs which are temporarily used to relieve the LES pressure are : nitrates, calcium channel blockers or botulinum toxin. Surgical procedures: Pneumatic dilatation and Heller's myotomy are the only durable therapies. Ref: Harrison's Principles of Internal Medicine, 18th Edition chapter 292.
Nitrates
PPIs
Esophagectomy
Heller's myotomy