Background: Achalasia cardia is an uncommon disease that is often detected late and is associated with significant morbidity. It is a primary esophageal motility disorder diagnosed based on a good history, barium swallow, upper endoscopy and a standard esophageal manometry.
Materials and Methods: We reviewed complete available records of treatment naïve patients with achalasia cardia from 1st January 2000 till April 2004.
Results: A total of 40 patients, with average presenting age at 44±16 (range 19-73) years with 14 males: 26 females with 20 Malays: 15 Chinese: 5 Indians, were suitable for further analysis. The classical symptom of dysphagia to liquids and solids were noted in all cases (100%). These patients learnt that water and sometimes-aerated drinks aid in flushing food down. Symptoms of regurgitation (36 patients-90%), heartburn (15 patients-37.5%), weight loss (10 patients–25%), nocturnal cough (16 patient-40%), retrosternal chest discomfort (2 patient-5%) and hemetemesis (2 patient-5%) was noted. One patient had aspiration pneumonia and another had concomitant active pulmonary tuberculosis and 8 had concomitant constipation (20%). In this series the duration of illness before diagnosis was 5±6 (range
0.3- 30) years and their presenting weight was 53±13 (range 33-82) kg. Barium swallow diagnosed achalasia in 27 patients (67.5%) and a dysmotility disorder in 7 cases (17.5%). There were 10 patients with mega-esophagus and two had epiphrenic diverticulum. There was no pseudoachalasia. Standard esophageal manometry, performed in 36 cases, demonstrated aperistalsis with one vigorous achalasia. The manometric assembly failed to pass through the sphincter in 14 cases and hence LOS assessment was not possible. Four cases demonstrated normal LOS pressure but demonstrated incomplete relaxation (normotensive achalasia). Pneumatic dilatation was performed in 38 newly cases without any complications with excellent symptomatic relief and a 3-12 month post procedural weight gain of 7±5 (range: 0-19) kg. Six patients required a second dilatation and another required two further dilatation. The durability of the total 45 pneumatic dilatations during this short study period was excellent at 24±12 (range 2-48) months.
Conclusion: A primary esophageal motility disorder must be excluded in any patients who present with dysphagia, with or without regurgitation and a "normal" upper endoscopy. Achalasia is not uncommon, often delayed in diagnosis and has a varied presentation. Although there is no cure for achalasia, but early detection and treatment certainly relieves symptoms and prevents complications. Pneumatic dilatation in our center has excellent durability without any complications.