Cardia spasm or cardia akathisia is an esophageal dysmotility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and lack of propulsive peristalsis of the esophageal body, which is the first known esophageal motility disorder. The annual incidence is about 1/100,000, with a male to female incidence ratio of 1:1.15, mostly seen in 20-50 years old, with a slight increase in women.
Etiology
The etiology of cardia spasm is still unclear. It is thought to be due to degeneration, reduction or absence of ganglia within the esophageal muscle layer.
Clinical symptoms
The main symptoms are difficulty in swallowing and a feeling of heaviness or obstruction behind the sternum. The disease has a long and recurrent course, the symptoms are sometimes mild and sometimes severe, the attacks are related to mental factors, more pronounced with solid food and cold liquid food, while hot food is easier to pass, initially intermittent attacks, as the disease progresses, later on it becomes persistent difficulty in eating. The lumen of the esophagus above the obstruction is compensated and dilated, often retaining large amounts of food and liquid, which can lead to aspiration pneumonia by aspiration.
Diagnosis
A barium x-ray can show the loss of peristalsis in the body of the esophagus, a bird’s beak shape in the lower esophagus and cardia with neat and smooth edges, and a marked dilatation of the upper esophagus, which can have liquid flat barium that cannot be passed. Gastroscopy can confirm the diagnosis and exclude tumor.
Treatment
The aim of treatment for cardia flaccida is to relieve LES relaxation disorder, reduce LESP and prevent complications. However, there is no effective treatment for the damaged intermuscular plexus.
Drugs
The drugs include nitrates, calcium antagonists, local anesthetics, anticholinergics, sedatives, gastrointestinal stimulants, and herbal medicines, which are only indicated for patients with early cardia.
Endoscopic botulinum toxin injection in elderly patients and high-risk patients has a short duration of symptom relief and a high recurrence rate in the medium and long term, and is only indicated for patients with other comorbidities that cannot tolerate surgery or balloon dilation. Contraindications include inability to cooperate, severe cardiopulmonary disease, local edema and stenosis that prevents passage of the guidewire.
Surgical treatment
Thoracoscopic surgery is recommended, which has the advantages of less trauma (only three small holes), less intraoperative blood loss and faster postoperative recovery, avoiding the disadvantages of traditional transabdominal or left-sided chest trauma and slow recovery. After the operation, the symptoms are obviously relieved, and the remission rate can reach 80%-90% with good results.
Complications
(A) Aspiration pneumonia
Bronchial and pulmonary infections can be caused when esophageal retained food reflux is inhaled into the airway, especially when sleeping. About 1/3 of patients may develop nocturnal paroxysmal choking cough or recurrent respiratory infections.
(ii) Complications of the esophagus itself
The disease can be secondary to esophagitis, esophageal mucosal erosion, ulceration and bleeding, press-out diverticulum, esophage-tracheal fistula, spontaneous esophageal rupture, and esophageal cancer. The complication rate of esophageal cancer is 0.3% to 20%. Among the 5235 cases of this disease reported in the literature between 1908 and 1975, 173 cases were complicated by esophageal cancer, with an average incidence of 3.3%, which is significantly higher than that of the general population and should be taken seriously.
(C) cardia spasm can be complicated by esophageal cancer or cardia cancer
The reason may be the long-term stimulation of the esophageal mucosa by the trapped material, ulceration and malignant change of mucosal epithelium proliferation, etc.
Prevention
Develop good dietary habits, eat less and more often, chew carefully, avoid too cold and too hot and stimulating diet. Psychological treatment can be given to those who are mentally nervous.