Symptoms and treatment of esophageal cardiospasm. With timely treatment of cardiospasm, radical measures are not required Cardiac spasm symptoms

Pathological narrowing of the esophagus, accompanied by inflammatory changes in the mucous membrane and impaired motility of the organ, expressed in the appearance of spasms, is called cardiospasm.

The disease has other names (megaesophagus, phrenospasm) and is expressed in a spasm of the cardiac region, which causes partial obstruction of food.

The disease begins with rare attacks that occur after severe nervous tension or fright, but gradually the spasms appear more often and are more protracted. Against this background, dysphagia (difficulty swallowing) occurs.

Diffuse spasm of the esophagus leads to impaired peristalsis along the entire length of the esophageal tube. It promotes stagnation of food, causes irritation of the mucous membrane of the esophagus, which in turn leads to pain. The pain is similar in nature to heart pain and therefore it is.

An attack is caused by hard, poorly chewed food, which, when passing through the esophagus, irritates the nerve endings located there. This provokes a spastic contraction of the esophageal tube. In this case, the functions of the lower (cardiac) sphincter are preserved. During an attack, the swallowing process is disrupted, dysphgia develops, and frequent manifestations of the syndrome lead to achalasia.

Cardiospasm and achalasia of the esophagus

Decreased relaxation of the cardia (the muscle ring that is located between the stomach and the esophagus) leads to stagnation of food in the esophageal tube, disrupting the movement of food into the stomach. Prolonged presence of food in the esophagus causes its expansion above the site of spasm.

First, the muscle layer of the organ thickens, and then the connective tissue grows (especially in the lower sphincter). Hyperemia appears on the epithelium of the esophageal tube, irritation, swelling, and with the progression of the disease – development.

Cardiospasm has 4 stages development and characterizes the degree of damage to the mucous membrane of the esophagus.

1 phase characterized by the unstable appearance of spasms, while the membrane of the muscular organ and the functions of the cardia are not impaired. The lumen of the esophagus is normal.

2 phase– attacks become more frequent and become stable. The esophageal mucosa becomes inflamed, and the esophageal tube itself expands.

3 phase– cicatricial changes and persistent significant expansion of the esophagus are observed.

4 phase characterized by stenosis (narrowing) of the cardia, while the esophagus takes on an S-shape, that is, it becomes deformed, lengthens, and esophagitis develops.

In addition, cardiospasm is divided into 3 types, which characterize a violation of the contractile function of the cardiac sphincter.

Hyperthroat– increased contractile function, which does not correspond to the load on the cardiac sphincter.
Hypoventricular– reduction of this function below normal.
Amotylnaya– motility of the cardiac sphincter is very low or absent.

Each stage of cardiospasm has its own symptoms.

Symptoms

As the disease progresses, symptoms increase. In the initial stage, the signs of the disease are almost invisible and are classified as manifestations of nervous overstrain (spasm against the background of strong emotional arousal). Subsequently, a clinical picture corresponding to this disease is observed, which consists of the appearance of:

The main symptom of achalasia is difficulty swallowing. First, the patient has a problem with swallowing solid food, and then liquid food causes an attack. To make it easier for food to move through the esophagus, the patient constantly drinks liquid.

Gradually, this does not bring relief to the patient, the spasms are repeated, which leads to fear of eating, refusal to eat and weight loss. It happens that cold food passes easier than warm food, and hard food passes better than soft or liquid food. It all depends on the individual characteristics of the body.

The second manifestation of the disease is regurgitation, that is, belching food. The attack develops against the background of overflowing of the esophagus with food and stagnation in it. The syndrome is provoked by bending the body forward, when additional pressure is created on the upper sphincter of the esophagus. This process is also observed in humans at night, when the muscle ring relaxes.

Pain syndrome occurs when the walls of the esophagus are stretched due to prolonged stagnation of food masses in it. It is characterized by dull pain localized along the esophageal tube. As the disease progresses, patients experience belching of air, bad breath, and a burning sensation along the esophagus, which is caused by fermentation of food masses.

Useful video

Cardiospasm of the esophagus, the symptoms of which are discussed in detail in this article, is an unpleasant phenomenon. Sometimes the best method is surgery. The features of the operation are described in this video.

(Video removed.)

Cardiospasm of the esophagus: treatment

For a disorder such as cardiospasm, treatment depends on the degree of the disease. In the beginning, it is possible to use drug treatment:

Treatment with medications is carried out in combination with a diet that excludes:

alcohol;
spicy;
sour;
salty.

Also, the patient should not eat solid foods, smoked foods, or hot foods. All this irritates the esophageal mucosa and leads to spasm. If the cause of spastic phenomena is considered to be the unstable emotional state of the patient, then he is prescribed sedatives.

If conservative treatment does not bring the expected results and attacks continue to torment the patient, then it is recommended to carry out a procedure that involves inserting a special probe into the muscular tube to help expand the lumen of the organ. The procedure may cause bleeding or bleeding, which will be an indication for urgent surgery.

If the implementation is ineffective bougienage perform surgery, which involves laparoscopic cardiomyotomy. This is a minimally invasive operation involving plastic surgery of the esophagus.

In particularly difficult cases (with significant damage to the esophageal tube), the esophagus is completely removed and replaced with an artificial one created from the stomach wall. This operation does not require repeated surgical repair of the esophageal tube.

Treatment with folk remedies is carried out in combination with other treatment methods. Chamomile decoction relieves inflammation and has an antimicrobial effect. Also shown at night teas having a calming effect ( mint, lemon balm).

Prevention

Prevention of the disease consists of timely treatment of diseases that provoke an attack, adherence to the principles of proper nutrition, as well as stabilization of the psycho-emotional state. Patients should refrain from quick snacks, stress, overeating, and eating immediately before bed.

When the first attacks appear, you need to go to the doctor for an explanation of the reasons.

Treatment of cardiospasm of the esophagus is a rather complex undertaking. Cardiospasm (achalasia) refers to a painful condition of the esophagus that develops due to spastic contraction of its walls during normal functioning of the lower sphincter. According to statistics, this disease is diagnosed in 6% of cases of all functional diseases of the esophagus. It should be noted that most often older people and the male population suffer from cardiospasm.

At the initial stages of the disease, doctors diagnose only functional disorders, which subsequently lead to organic changes, starting with hypertrophy and ending with a strong expansion of the lumen of the esophagus. That is why the disease should never be started. At the first symptoms, you should seek help from a doctor.

The main complaint of patients with achalasia is the inability to swallow normally. At first, patients cannot swallow only liquid food, and as the disease progresses, they cannot swallow solid food, which often has to be taken with large amounts of liquid.

In the early stages, esophageal achalasia can be treated with medications. Doctors, as a rule, prescribe long-acting nitrates, antacids, which very effectively neutralize the hydrochloric acid contained in gastric juice, local anesthetics aimed at reducing sensitivity, sedatives, which have a sedative but not hypnotic effect, and calcium channel blockers. It is very important that the patient normalizes his diet and refuses sour and spicy foods. Do not eat too hot or cold food, which can injure the esophageal mucosa. You should avoid alcohol, which also has a very negative effect on this organ.

Patients should avoid intense physical activity and frequent nervous strain. Frequent stress interferes with the normal functioning of all human organs, the esophagus being no exception.

If medications do not give the desired result, then doctors resort to other methods of treating cardiospasm of the esophagus.

Most often, esophageal achalasia is treated with balloon dilatation of the cardia. This technique involves fixing a dilator, which looks like a small rubber balloon, on the gastric tube. It helps achieve cardia expansion. The balloon is inflated with air until a pressure of about 300 mmHg is achieved. As a result of stretching of smooth muscles, paresis of the cardia occurs, which leads to a decrease in the esophageal-gastric pressure gradient, the disappearance of dysphagia and the restoration of food passage. The course of treatment should consist of at least 5 such sessions.

It should be noted that some complications may appear in the coming hours after cardiodilation. Such complications include rupture of the esophagus with the development of mediastinitis and severe esophageal-gastric bleeding. When such complications occur, doctors are forced to take urgent measures.

Surgical intervention

If necessary, doctors perform surgery. The indication for surgery is significant functional changes in the esophagus, which persist even after several procedures of balloon dilatation or long-term use of medications. Many doctors agree that if even after the second dilatation procedure the patient does not show improvement, then it is worth starting surgery.

Laparoscopic cardiomyotomy according to Heller is very popular. This minimally invasive and highly effective operation is often performed in cases where grade 3 esophageal achalasia is diagnosed. This surgical intervention is performed under anesthesia; in rare cases, a complication such as reflux esophagitis may develop after it.

If this disease is combined with a duodenal ulcer, then doctors additionally perform selective proximal vagotomy. Vagotomy is a method of surgical treatment of chronic ulcerative diseases. During this operation, a specialist cuts off individual branches or the trunk of the vagus nerve. Due to this, denervation of the secretory cells of the stomach occurs, which produce hydrochloric acid, thereby reducing the negative impact on the mucous membrane.

In very severe cases, such as grade 4 achalasia, laparoscopic cardiomyotomy cannot be performed, as severe atony and deformation of the esophagus are observed. In this case, doctors perform extirpation of the esophagus with esophagoplasty. We are talking about completely removing this organ and replacing it with a “tube” from the wall of the stomach. Although this operation is very complex, in most cases it leads to a complete cure of the patient.

Treatment of illness with folk remedies

Cardiospasm of the esophagus of the 1st degree can be treated with folk remedies. Currently, there are a lot of home recipes that will help cope with unpleasant symptoms. Therefore, every patient will be able to find something that is most suitable for themselves.

A simple potato can help with this ailment - you need to peel the vegetable, cut it into thin slices and start slowly chewing the potato slices one after another. Relief should occur within 10-15 minutes.

At home you can prepare a very effective decoction of marshmallow root. To prepare such a decoction, you will need to grind the marshmallow roots and pour 6 g of the resulting mass into 1 cup of boiling water. The resulting consistency should be poured into an enamel bowl and put on fire for at least 30 minutes. The broth should be boiled covered. As soon as the liquid has cooled slightly, it should be filtered and taken orally, 150 ml 2 times a day after meals.

Celery root juice will help cope with achalasia of the esophagus. It is recommended to take 3 tablespoons at least 3 times a day. The course of treatment is 3 weeks.

You can also make a tincture from celery roots. To do this, the roots of the plant must first be ground into powder, after which 2 tablespoons of the resulting mixture must be poured with 1 glass of boiled water. The product should be infused for 20 minutes. The finished tincture should be taken orally, half a glass 3 times a day. The best time to take this tincture is 30 minutes before meals.

Whole oat grains will help improve the condition of the esophagus. They should be chewed slowly throughout the day.

At home, you can cure cardia achalasia using a special mixture of 2 tablespoons of bitter wormwood, 1.5 tablespoons of mountain arnica and 4 tablespoons of saxifrage root. All ingredients are mixed. Place 3 tablespoons of the resulting mass in a thermos and add 400 ml of boiled water. The collection must be infused for 12 hours. The finished product should be strained and drunk in small sips 4 times a day 30 minutes before meals.

A decoction of oak bark will also help to cope with the disease - 30 g of oak bark should be mixed with the same amount of cinquefoil rhizome, 40 g of walnut leaves, 20 g of oregano and 40 g of St. John's wort flowers. All ingredients should be thoroughly chopped. 3 small spoons of the resulting mixture should be filled with 700 ml of cold water. The product should be infused for 3 hours. After this, the medicine must be put on the fire, brought to a boil, kept on the fire for several minutes and removed from the stove. Strain the cooled mixture and take 4 tablespoons before meals.

Also very popular is a decoction of chamomile, which has a calming effect - pour 1 spoon of chamomile flowers into 1 glass of boiling water and wait 30 minutes. The finished broth should be filtered and taken orally 3 times a day.

Before using any folk recipes for cardiospasms of the esophagus, you should consult a doctor who will help you avoid serious complications.

The occurrence of a pathological condition, such as cardiospasm of the esophagus, brings the body a reflexive relaxed state of the lower sphincter during swallowing reflexes.

As a result, incoming food in lumps accumulates in the food duct, and expands its upper sections.

This is a pathology that has no age restrictions or gender, so it equally affects all segments of society and gender.

When the first signs of this pathology appear, it is necessary to urgently visit a doctor and undergo the diagnosis prescribed by him with the necessary treatment.

The main and first signs include:

dysphagia;
a sharp decrease in body weight;
pain in the chest compartment (sternum).

In order to correctly diagnose esophageal cardiospasm, the doctor uses instrumental and laboratory diagnostics of the patient’s body.

Therapy for this type of disease is carried out by surgical intervention or by a conservative approach to treatment.

These methods are prescribed and selected by the doctor, depending on the course of the disease and the occurrence of possible complications.

Cardiospasm of the esophagus - characteristics of the disease

This pathology is expressed by the complete or partial absence of the swallowing reflex and contraction of the lower sphincter.

The cause of this condition is a complete failure of the motility of the esophagus.

The spasms resulting from this create stagnation of food contents in the esophagus, which leads to an increase in the upper part and the appearance of an inflammatory state of the digestive organ.

The esophagus changes its shape due to the development of different stages of the pathological condition:

the initial stage of development of the pathological disease - no changes are observed;
an increase in the esophagus by 3-4 cm occurs at the second stage of the disease;
expansion of the esophagus up to 6 cm and thickening of the walls - indicates the third stage of development;
the fourth stage leads to lengthening of the esophagus and a change in its appearance to a peculiar shape in the form of the English letter S.

The main risk group for this pathology are people with obvious signs of mental disorder, but also different segments of society, regardless of status and age, as well as gender.

In some cases, children begin to suffer from this pathology, in whom this disease usually occurs in a severe form due to a fragile body.

Esophageal Disease Clinic

For the initial stage of the disease, certain symptoms of the disease are expressed, and as the pathology develops, they become more noticeable and pronounced. The main and obvious symptom is dysphagia.

This symptom and pathological deviation from the norm is expressed in a violation of the swallowing reflex, which leads to an abundant accumulation of food in the esophageal tube.

In addition, this symptom is characterized by two main features:

belching with the smell of rotten and fermented food;
severe bursting pain in the chest caused by an enlarged esophagus.

These symptoms are supplemented by general signs and troubles associated with this pathology:

severe weakness of the whole body;
lack of appetite;
sudden weight loss;
chronic manifestations of diseases of the human cardiovascular system.

The lack of timely treatment of this pathology brings additional diseases to the patient’s body:

pulmonary pneumonia;
abscesses of internal digestive organs and blood vessels;
pulmonary atelectasis.

When the first signs and causes characteristic of this pathology appear, it becomes the first alarm bell, in which action must be taken without delay.

Timely therapy will save the patient from severe and serious complications.

The course of treatment is prescribed by the attending doctor, according to the diagnostic measures performed. Self-medication in this situation is dangerous to life and health.

The occurrence and causes of this pathology

Even despite the development of science and medicine, scientists have not yet fully identified the cause of this pathology.

There are opinions that the development of this disease is preceded by the following factors:

mental disorders;
stressful situations;
structural changes in the tissues of nerve endings that are responsible for the reflexes of the body and the esophagus itself.

The development of the above factors creates conditions for malfunction of nerve endings and untimely contraction of the smooth muscles of the esophagus.

Inconsistency in work interferes with the movement of food along the tube channel, which leads to its accumulation and inflammatory disease.

In addition, increasing the tone of the muscular system plays an important role in the development of this pathology and increased tone of the food tube.

General therapeutic measures

Therapy for cardiospasm of the esophagus is carried out conservatively and surgically and depends on the development and complexity of the pathology, symptoms of the disease.

Conservative treatment includes the use of medications, dietary therapy, and adherence to a daily and nutritional regimen.

What medications are prescribed for cardiospasm of the esophagus (achalasia cardia):

antispasmodics;
sedatives;
calcium antagonists;
agents having the ability to envelop;
prokinetics.

When starting treatment, dietary measures are prescribed according to table No. 1 prescribed by the nutritionist.

Treatment with folk remedies is also allowed, which includes the use of tinctures, but only with the agreement of the attending physician, since, having a picture of the pathology in hand, he will be able to correct this treatment.

In some cases, to normalize the general condition and improve reflex swallowing, doctors can use minimally invasive methods of therapy, which involves installing a resorbable stent or balloon dilatation.

If there is no improvement in the patient's condition, surgical intervention is used.

Diet therapy

In case of pathology of this disease, dietary treatment is prescribed. Patients suffering from cardiospasm are prescribed dietary food with dietary table No. 1.

Food is consumed in liquid or ground form, in small portions 2-3 times a day.

It is completely forbidden to eat salty, sour, spicy, fatty, and hot foods.

You need to eat slowly, chewing your food thoroughly. Types of foods that it is advisable not to consume or reduce consumption:

fresh baked goods;
fermented milk products;
apples of all types and varieties;
peaches;
boiled potatoes;
meat of fatty varieties and breeds.

It is forbidden to eat before bedtime, as this will lead to stagnation in the esophagus and putrefaction of lumps of food.

Drug therapy for the pathology of cardiospasm of the esophagus

At the onset of the disease, this pathology is amenable to drug treatment. Therapy in this situation is carried out in a complex, and medications and tablets have a wide spectrum of action.

First of all, a certain group of medications has a relaxing effect on the muscles and musculature in the lower part of the esophagus.

This group of drugs includes:

Dinitrate;
Nitroglycerine;
Isosorbitol.

Cardiospasm of the esophagus, treatment requires complete relaxation of the smooth muscles so that food can pass freely through the tube.

For this, myotropic antispasmodics are used. This group includes the following drugs:

Halidor;
Papaverine;
Drotaverine tablets.

These drugs relieve muscle spasms and reduce the patient's pain. Doses of use are prescribed by the doctor, according to the pattern of the course of this pathology.

It all depends on the stage of development of the disease, the severity of the disease, and the individual characteristics of each organism separately.

To speed up the healing process, additional restorative therapy is carried out.

It improves the condition of the immune system and the general condition of the patient's body. What is included in the general health course of treatment of this pathology:

vitamin groups B;
vitamin C;
the use of glucose as a substitute and maintenance of the body.

Therapy takes place with full compliance with dietary nutrition and a gentle diet regimen.

Medicines are selected so that if they get stuck in the duct, they do not cause irritation of the walls of the esophageal mucosa.

In other cases, with the development of serious pathology of cardiospasm of the esophagus, drugs are used by injection. Balloon dilation works well.

What is balloon dilatation

The balloon dilatation method is recognized as the most effective way to treat esophageal cardiospasm.

This procedure is performed under general anesthesia. The principle of therapy is to introduce a balloon dilator into the body of a sick person, which is a specially invented device with a balloon at the end of a medical tube.

This action has the ability to stretch the lower food channel of the esophagus. After this event, the process of reflex swallowing improves.

By performing several of these procedures, there is a significant improvement in the swallowing effect. This procedure is carried out in a course and after a certain period of time.

This procedure is unsafe for humans. The main danger is the possibility of damage and rupture of the walls of the esophagus.

If the walls of the mucous membrane of the esophagus rupture, urgent surgical intervention will be required to eliminate the consequences of this rupture.

In some cases, this procedure, if carried out inappropriately, can cause death and accounts for 2-4% of the total dilatation rates.

In addition to this unpleasant moment, mechanical damage to the esophagus can also occur, which will cause internal bleeding into the stomach and duodenum.

Therefore, to avoid side effects and processes, this procedure must be performed only by specialists of high medical rank.

Surgical treatment of this pathology of cardiospasm

What is this surgical procedure? The sequence of actions for this operation:

between the seventh and eighth ribs the patient’s thoracic region is opened;
the distal part of the esophagus is separated from the tissues of other organs;
cut muscles up to 10-11 centimeters long.

This operation is performed at the last stage of the disease and brings positive benefits for the health of the sick person. Sometimes treatment is prescribed using traditional medicine.

Therapy using traditional medicine

Using traditional methods of therapy, you can try to relax the muscle tissue of the larynx. For this purpose, sedatives are used.

The following organics have sedative properties:

valerian;
motherwort grass;
peony grass.

Medicinal decoctions are created from this vegetation. True, failure to follow the rules for preparing tinctures can not only help with this pathology, but also cause serious harm to the body of a sick person, which is why it is better to purchase these drugs at pharmacy kiosks.

Moreover, they do not cost a lot of money and are sold freely. These methods are used for treatment only in conjunction with drug treatment, according to courses prescribed by the doctor.

Inflammatory processes associated with cardiospasm of the esophagus are also relieved with the help of tinctures of the following plants:

chamomile;
oregano herbs;
alder leaves;
marshmallow root vegetable;
quince seed.

To increase muscle tone in the lower part of the esophagus, the following tinctures are used:

Chinese lemongrass;
ginseng root;
eleuthorococcus leaves.

Therapy with traditional methods is widely used only at the early stage of the disease.

In other cases, only as an aid to drug treatment.

Preventive measures against this pathology of the esophagus

To prevent this disease or stop the progression of esophageal pathology, it is necessary to organize a proper and healthy diet.

To do this, you need to review the food menu and turn off rough foods from it, refuse fast food in public catering, eliminate overeating and follow a daily routine.

It should be remembered that early contact with doctors will prevent serious consequences for the health of the victim from this disease pathology.

Strict adherence to the rules and daily routine, playing sports and physical therapy will completely eliminate the possibility of developing this human disease.

Prognosis of the pathology of cardiospasm

For this pathology, the prognosis becomes positive only with early access to a medical institution, and timely diagnostic measures are the best way to identify the disease at an early stage of its development.

Useful video

Functional diseases of the digestive tract are encountered quite often in the practice of therapists and gastroenterologists. This applies not only to stomach pathology. Problems associated with the functioning of the esophagus occur in young patients of working age. They occupy the third position in the structure of diseases of this organ, accompanied by dysphagia. At the same time, esophageal cancer and chemical burns are in first place.

Stages of achalasia cardia

Achalasia, or cardiospasm of the esophagus, is an idiopathic disease, the etiology of which is considered to be not fully understood. However, there are hypotheses that attempt to explain what causes this condition.

The essence of pathology

The cardia is the place where the proximal portion of the esophagus passes directly into the cardia of the stomach. This section is located under the diaphragm. Inside its wall there are smooth muscle fibers that determine the tone of this area. They form the so-called lower esophageal sphincter, the function of which is to ensure a unidirectional flow of food and liquid towards the stomach.

With achalasia, or cardiospasm, the normal processes of coordination between swallowing at the pharyngeal level and peristalsis of the esophagus are disrupted.

Neuromuscular transmission becomes pathological, and prolonged spasm of the lower esophageal sphincter (cardiospasm) occurs. The term achalasia in this situation emphasizes the lack of a proper period of relaxation of the muscle fibers of the distal esophagus.

Possible factors for the development of the disease

The development of the clinical picture of cardiospasm is associated with dysregulation of muscle contraction and relaxation. It is known that the autonomic innervation of the esophageal wall is carried out by fibers of the parasympathetic nervous system. One of the evidence that achalasia cardia is a neuromuscular disease is the identification of inflammation of the submucosal and intermuscular plexuses (located intramurally, inside the wall of the organ).

The exact causes of achalasia cardia have not been established

There are a number of theories that attempt to explain why cardiospasm occurs. The most popular among them are the following:

Hereditary character.
Infectious mechanism.
Autoaggression correlated with the presence of achalasia.

The hereditary theory of development is confirmed by the fact that in the family of a patient with cardiospasm there are always relatives with symptoms of dysphagia. Attempts are being made to prove the genetic cause of the development of the disease.

Autoimmune diseases in achalasia cardia are several times more common. In the vast majority of cases, this pathology develops in parallel with hypothyroidism. According to studies by Canadian scientists, with cardiospasm the risk of systemic connective tissue diseases (systemic lupus erythematosus, scleroderma, Sjogren's syndrome) increases tenfold. A detailed examination revealed the presence of special immunoglobulins. They are called neuronal antibodies, because they act on various components of neuromuscular transmission. Another evidence of the autoimmune nature of achalasia is the frequent development of type 1 diabetes mellitus.

Infectious agents are also discussed as participants in the pathogenesis of achalasia. It is believed that the herpes and measles viruses cause neuromuscular degeneration in the wall of the esophagus in a certain percentage of cases. Some infectious disease specialists insist on the view that achalasia is caused by trypanosomes as part of trypanosomiasis. It is at the second stage of this infectious disease that conditions appear for a massive accumulation of microorganisms in the muscular structures of the esophagus and cardiac tissue. Inflammation occurs in the Meissner and Aeurbach plexuses, which leads to dystonia of the muscle fibers of the esophageal wall.

Clinical manifestations of the disease

The most common symptom is difficulty swallowing. Dysphagia is manifested by a feeling that a bolus of food is stuck in the chest area and then sharply falls down. Gastroenterologists distinguish two possible variants of dysphagic manifestations.

In young patients, swallowing disorders occur acutely. They are usually able to remember from what period of time this symptom bothered them. Many argue that its occurrence was preceded by one of the following situations:

nervous tension;
stress;
problems at work;
Excitement about a demanding work or study situation.

Swallowing disorders include difficulty swallowing solid foods.

It stands “lumpy”, causing discomfort and pain behind the sternum. This forces patients to repeat swallowing movements several times, walk while eating, and drink water or tea. Over time, the situation becomes progressive, and paradoxical dysphagia may occur, when liquid food passes through the esophagus worse than solid food.

Gradual development of dysphagia is the second option. It is more typical for people over 40. Swallowing problems appear very slowly and smoothly. There are no acute situations that provoke this phenomenon. Therefore, patients are unlikely to be able to give a definite answer when the disease began.

Achalasia cardia is characterized by the development of dysphagia

Reverse reflux of food from the esophagus into the oropharynx is the next typical symptom of esophageal achalasia. Gastroenterologists call this manifestation regurgitation. It can be active and passive.

Active reflux of food appears at the onset of the disease. Its volume and time of appearance indirectly indicate how serious the disease is. If regurgitation appears almost immediately after eating, like regurgitation, then we are talking about the disease being in the earliest stages of its development.

Passive reflux of food into the oropharynx is provoked by the patient's horizontal position and bending forward. Surgeons describe "wet pillow syndrome," in which food particles and mucus are thrown into the oropharynx and onto the bed during the night's rest. This manifestation marks the decompensation of the disease.

Quite often, patients with cardiospasm of the esophagus experience the appearance of retrosternal pain. They resemble the pain syndrome that develops with heart disease. But the factors that provoke its occurrence are somewhat different. This is eating cold or hard food, emotional stress.

Weight loss is typical for patients with achalasia. Patients spare themselves because they are afraid of pain and discomfort when swallowing. Therefore, they eat less food.

Diagnostics

In order to confirm esophageal achalasia, it is necessary to differentiate the manifestations from the following diseases:

Cancer of the junction from the esophagus to the stomach.
Angina pectoris.
Esophagitis as part of gastroesophageal reflux disease.
Peptic esophagitis.
Narrowing of the organ lumen due to a burn.

In diagnosis, general clinical, endoscopic, and fluoroscopic research methods are used.

Esophagometry

Fibrogastroduodenoscopy will assess the condition of the organ mucosa and rule out the presence of esophagitis. Histological analysis of the biopsy will determine the presence of atypia and cancer. X-ray examination of the esophagus using radiopaque compounds is necessary not so much to verify the diagnosis as to determine the extent of the lesion.

Treatment approaches

Cardiospasm (achalasia) of the esophagus requires either surgical treatment or conservative measures. An alternative option is fluoroscopy-guided pneumodilatation.

Balloon pneumodilation of the esophagus

Achalasia can be treated conservatively if surgical intervention is not possible. Drug therapy involves the use of drugs that relax the lower esophageal sphincter. In this case, a drug such as Nifedipine is prescribed. It is a calcium channel blocker that has been successfully used in the treatment of hypertension and angina. An alternative option is nitrates. Treatment with folk remedies is justified when it complements the main methods of therapy.

In case of passive regurgitation and severe decompensation of the disease, esophagocardiomyotomy with Heller-Dor fundoplication is indicated. This operation is accompanied by excision of the esophageal wall to eliminate spasm. Fundoplication is necessary to prevent the development of reflux.

When conduction is disrupted, very serious consequences occur, as with cardiospasm and achalasia of the esophagus. Food remains are retained, provoking inflammatory reactions and intoxication. Chronic starvation syndrome is formed, which leads to disruption of all types of metabolism, and therefore to disruption of the functions of all systems and organs. In addition, constant pain, dysphagia and regurgitation have a negative effect on the patient’s psyche.

What is esophageal cardiospasm and its causes?

Cardiospasm of the esophagus is a persistent contraction of the muscles of the terminal (end) part of the organ, occurring against the background of dysfunction of the central parts of the parasympathetic ANS (autonomic nervous system) and accompanied by a morphological restructuring of its proximal (upper) parts.

Histological examination reveals abnormalities in the neurons of the dorsal nuclei n. Vagus, as a result, the smooth muscles of the lower sphincter become more sensitive to the tonic action of gastrin. This is a hormone and natural mediator released when the stomach is stimulated by food, its smell or sight. As a result, the distal esophagus is constantly under the influence of tonic impulses. A true spasm of the cardia develops.

The causes and mechanisms of development are not entirely clear. Now most authors adhere to the following theories of the occurrence of the disease:

The theory of genetic mutations is the most popular. Mutations lead to insufficiency of certain enzymatic systems (NO synthetase), as a result of which the physiology of smooth muscle contractions is disrupted.
The theory of autoimmune lesions. This theory is confirmed by the fact that antibodies that can provoke cardiospasm are detected in the blood of patients.
The theory of viral infection. The role of viral infection with the Herpes Zoster virus (herpes zoster virus) in the development of ANS damage and the occurrence of cardiospasm is discussed.

Symptoms in adults

Achalasia and cardiospasm of the esophagus, symptoms, treatment, types of operations - all these issues have been developed in detail by the Russian gastroenterological school (Petrovsky B.V., Vasilenko V.Kh.).

When diagnosed with esophageal cardiospasm, the symptoms are as follows:

swallowing disorder;
thoracalgia – pain in the chest area;
regurgitation - reflux of gastric contents into the esophagus.

The disease usually develops gradually; there are cases of acute onset, when signs of dysphagia appear at the height of severe emotional stress.

The clinic of swallowing disorder with cardiospasm has characteristic features.

Dysphagia is not constant, it occurs:

when swallowing solid food;

when swallowing foods containing large amounts of fiber;

with fast eating and insufficient chewing of food.

Sometimes paradoxical dysphagia occurs, when it is difficult to swallow liquid food, but solid food is swallowed well.

Thoracalgia occurs more often in the retrosternal region (behind the sternum), after eating. This is the result of stretching the walls of the esophagus. The pain may worsen on an empty stomach, which is associated with inflammation in the esophagus. Sometimes thoracalgia is not related to the act of swallowing, but occurs during physical activity or excitement.

A characteristic symptom of cardiospasm is regurgitation. Active regurgitation is more characteristic of the initial stages, when emptying of the esophagus occurs immediately after eating. With severe dilatation of the esophagus, regurgitation is delayed, but of a much larger volume. Passive regurgitation occurs independently of food intake - when bending over or in a horizontal state.

Most patients experience noticeable weight loss, and some, with severe disease, experience cachexia - an extreme degree of exhaustion.

Stages of the disease

There are many different classifications of cardiospasm, but the classification of Academician B.V. remains generally accepted. Petrovsky, who distinguished 4 stages in the disease.

Cardiospasm of the esophagus: stages according to B.V. Petrovsky:

I – stage of intermittent, functional spasm of the cardia, no signs of esophageal dilatation;
II – stage, when the spasm of the cardia becomes stable, a slight dilation of the esophagus;
III – stage, at which the muscle layers of the cadia are scarred, the esophagus expands significantly;
IV – stage, stenosis of the cardia is pronounced, with significant lengthening, expansion, and deformation of the esophageal tube.

Diagnostics

Laboratory tests do not play a significant role in the diagnosis.

Basically, the diagnosis of the disease is based on x-ray, endoscopic studies and manometry.

. The main radiological sign is a cone-shaped narrowing of the esophagus with the apex in the region of the cardia, the overlying parts of the organ are dilated, sometimes significantly, the peristalsis of the organ is impaired, and there is no gas bubble in the stomach.
An endoscopic examination allows one to determine how dilated the upper parts of the esophagus are and the severity of inflammatory and metaplastic changes. Although the cardiac sphincter is closed, in case of cardiospasm it is usually possible to enter the stomach during endoscopy; if the fiberscope does not pass into the stomach, then it is necessary to exclude oncological pathology.
Manometry can confirm the diagnosis. The main manometric syndrome is the absence or decreased relaxation of the LES during swallowing. The study reveals an increase in pressure in the area of the lower sphincter and impaired peristalsis.

Cardiospasm and achalasia of the esophagus: differences

Cardiospasm and achalasia of the esophagus are two different nosologies. Esophageal achalasia is a disease characterized by persistent loss of the LES relaxation reflex in response to the act of swallowing. Motility of the esophagus is sharply reduced. The cardiac sphincter expands only under the influence of the gravity of swallowed food and liquid. Histologically, a disorder is detected only in postganglionic neurons. Since the central sections of the ANS are not changed, increased sensitivity to gastrin is not observed.

Cardiospasm and achalasia of the esophagus, their differences are that these diseases affect different levels of the parasympathetic ANS.

Cardiospasm of the esophagus: treatment

Conservative treatment is ineffective for cardiospasm, but patients are often prescribed: nitrates (nitroglycerin), calcium antagonists (nifedipine), antispasmodics (no-spa), prokinetics (domperidone). These drugs are not able to cure this pathology. But in stages I-II of the disease, nitroglycerin can temporarily relieve cardiospasm.

For what types of cardiospasm is surgical treatment indicated?

The indication for surgical intervention is a narrowing of the cardia with an S-shaped elongation of the esophagus.

The operation is carried out:

if it is not possible to perform cardiodilation (especially in pediatrics);
in the absence of results from repeated courses of cardiodilation;
with rupture of the esophagus caused by cardiodilation.

Balloon dilatation

Drug therapy for cardiospasm is rarely successful. The main method of treating cardiospasm is balloon dilatation. The operation is performed using a soft probe with a balloon at the end. Balloon dilatation is a forced stretching of the lower esophagus with partial rupture of its muscle tissue.

After anesthesia, under X-ray or endoscopic control, a probe is inserted into the esophagus, the balloon is inflated with air to a certain level, and the exposure of the procedure is determined individually. In most cases, after such manipulation, the act of swallowing in patients becomes easier.

Surgery

If there are no results from conservative treatment and bougienage, patients are prescribed surgical treatment.

Currently, laparoscopic myotomies are used. In the terminal stage, extirpation or subtotal resection of the esophagus is performed.

Recovery period after surgery

After the operation, the patient is placed in the intensive care unit, where he is constantly monitored throughout the day. The patient is prescribed a complex of sedative, restorative and analgesic therapy. Diet therapy is being developed. In case of uncomplicated course of the disease, after a few days the patient is transferred to the ward mode. In order to prevent complications, early physical activity is practiced: the patient sits in bed, gets up, and walks around the ward. Here it is important to provide the patient with good care, including proper nutrition, hygiene standards, and psychological peace.

After discharge from the hospital, the patient is sent to outpatient treatment. He is supervised by a gastroenterologist for a year. It is mandatory to regularly examine the surgeon.

Diet for cardiospasm

Food should be taken in pureed, semi-liquid form, chewing thoroughly. Repeated meals in small portions should be established. Table No. 1a and 1b according to Pevzner. In some patients, there are products that individually increase cardiospasm; it is better to exclude such products from the menu. You should not eat immediately before bed. It is necessary to sleep with the head of the bed elevated to prevent aspiration into the respiratory tract.

Alternative medicine

Treatment with folk remedies can be used as an addition to general therapy. They can be used at home during stage I of the disease, and after bougienage or surgery.

To eliminate inflammatory phenomena during esophagospasm, she recommends infusions of alder, quince seeds, oregano or chamomile.

If the symptoms of cardiospasm intensify due to nervousness, then tincture of valerian, peony, and motherwort is recommended.

Cardiospasm of the esophagus in children

In children, as in adults, the basis of the pathological process is the spastic contraction of the LES and an increase in the diameter of the proximal parts of the organ. This disrupts the tone and motility of the esophagus. In children, organic stenosis and hypertrophy of the muscles of the abdominal esophagus are not detected.

Causes

Histological studies in children with cardiospasm reveal a congenital deficiency of intermuscular neurons, resulting in congenital denervation of the smooth muscle fibers of the esophagus.

Cardiospasm of the esophagus: treatment in children

Children of any age are affected, including infants, but the majority of patients are preschoolers. The disease develops gradually, but with a clear tendency towards chronicity.

Cardiospasm of the esophagus, the symptoms of which are pronounced, is diagnosed quite easily.

The clinical picture of the disease in children is dominated by two symptoms: dysphagia and regurgitation.

Regurgitation is not detected after every feeding. This is vomiting of food eaten without any admixture of gastric juice, or vomiting of mucus.

Dysphagia in infancy and toddlerhood is determined by a number of indirect signs: the baby refuses the breast, chews food for a long time, and often resorts to washing down food with water.

How to treat cardiospasm of the esophagus in children

The main methods of treatment in pediatrics are: cardiodilation and surgical treatment. Medications are ineffective. Pediatric cardiospasm surgery has been thoroughly developed. During surgical treatment, cardiomyotomy according to Geller or diaphragmocardioplasty according to Petrovsky is most often performed.

The results, both immediate and long-term, for children are good. The symptoms of the disease pass, but it is not possible to completely cure; the esophagus, as a rule, remains dilated.