Achalasia cardia is primary esophageal motility disorder characterized by the absence of esophageal peristalsis. It leads to impaired relaxation of the lower esophageal sphincter (LES) in response to swallowing, causing heart burn, chest pain and regurgitation. Barium swallow will give bird beak appearance and esophageal dilatation.
Medications:
- Cap. Depin 10 (Nifedipine 10 mg) 1 capsule thrice a day 30 minutes before meals.
General advice:
- Avoid irritant substances like salicylates, NSAIDs, spicy food, etc.
- Advice patients to chew slowly to allow adequate mixing with saliva and wash down the finely chewed food with liquid. Avoid gulping of food, swallowing unchewed food particles.
- Advice semisolid, bland or liquid diet.
- Advice Valsalva maneuver or hyperextension of neck and chest to facilitate oesophageal emptying..
- Several rapid successive swallows of warm liquid.
Foods to include
- Adopt a softer and pureed diet like soups, porridge, mashed vegetables as this will help in swallowing.
- Include protein rich foods like chicken, fish, soya and eat more high fibre.
- Ginger plays a role in helping digestion in our body and prevents heartburn.
- Dairy products like milk and yogurt work very well in easing symptoms of digestive discomfort.
- Peppermint is known to help reduce gastric acid secretion.
- Thickened fluids like broth, stew, vegetables or juices can be consumed.
- Drink at least 10 glasses of water daily to stay hydrated.
Foods to avoid
- Avoid fried and spicy foods as they act as irritants and worsen the symptoms.
- Avoid high carbohydrate foods like potatoes, cauliflower, wheat, rice as they are known to slow down the digestive process.
- Consume citrus fruits like lemon, oranges etc. in moderation as they are known to increase acid reflux.
- Reduce consumption of caffeine in your daily routine (maximum 2 cups of tea or coffee daily).
- Avoid too much beverages and aerated drinks.
Investigations:
- Upper G.I. endoscopy – to rule out structural pathology, ulcers, gastritis
- Esophageal manometry – to confirm the diagnosis
Referral:
Consider referring the patient to gastroenterologist if there is inadequate response to above therapies or if patient presents with additional complications.