30 years of women come with dysphagia for both solid & liquids & barium swallow shows Parrot beak appearance. On oesophagal manometry, increased LES pressure. Management includes Except
ACHALASIA CARDIA is the failure of relaxation of oesophagogastric junction due to disorganised oesophageal peristalsis.aetiological factors include stress, vitamin b1 deficiency, Chagas&;s disease.it is a precancerous lesion chance to transform into squamous cell carcinoma.common in females of 20-40 yrs, presents with progressive dysphagia, more to liquids than solids, regurgitation and recurrent pneumonia, heaburn, and lung abscess.a barium swallow is diagnostic and shows pencil like smooth narrowing of the lower oesophagus (bird beak appearance) and dilatation of proximal oesophagus (cucumber oesophagus).chest x-ray shows patches of pneumonia, manometry reveals unrelaxed lower oesophagal sphincter.differential diagnosis includes *carcinoma oesophagus *scleroderma *stricture oesophagus.treatment includes drugs such as nifedipine, botulinum toxin, and nitroglycerin.surgical includes *modified heller&;s operation *POEM(peroral endoscopic myotomy *forcible dilatation Ref: SRB&;s manual of surgery,5th ed, pg no 798
Nitrates
Ca channel blockers
Botulinum toxin
Myotomy (POEM)
G.I.T