Cardiac Achalasia

It is characterised by the absence of peristalsis in the body
of oesophagus and high resting pressure in lower
oesophageal sphincter; the latter also does not relax during
swallowing.
The symptoms of cardiac achalasia include dysphagia,
which is more to liquids than solids (reverse of that seen
in malignancy or strictures) and regurgitation of swallowed
food particularly at night.
The diagnosis is made by: (a) radiography (barium
swallow shows dilated oesophagus with narrowed rat tail
Lower end), sumetimes also called bird-beak appearance;
(b) manometric studies (low pressure in the body of
oesophagus and high pressure at lower sphincter and failure
of the sphincter to relax); (c) endoscopy (to exclude
benign stricture or any development of carcinoma which
is a common complication of this disorder.
The treatment of choice is the modified Heller's operation
(myotomy of the narrowed lower portion of the
oesophagus). Forceful pneumatic dilatation of the lower
oesophagus can be done in those unfit for surgery.