Symptoms of achalasia of the cardia

Typical symptoms of achalasia cardia are as follows:

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Dysphagia

Dysphagia (difficulty swallowing) occurs in 95-100% of patients.

Dysphagia is the very first and main symptom of achalasia cardia. It has the following features: it occurs inconstantly (during excitement, fast eating, insufficient chewing of food), is provoked by certain foods (usually those containing a large amount of fiber - fruits, rye bread, etc.), can be paradoxical (solid food passes through the esophagus better than liquid, and large amounts of food are better than small ones).

Dysphagia intensifies after nervous excitement, rapid ingestion of food, especially poorly chewed food, accompanied by a sensation of food stopping in the esophagus and “falling” into the stomach, and decreases under the influence of various techniques found by the patients themselves (for example, walking, gymnastic exercises, repeated swallowing movements, swallowing air, drinking plenty of water).

Feeling of fullnessin the epigastric region and behind the breastbone. This painful feeling forces patients to tense the muscles of the upper body in various ways while holding their breath, in order to improve the passage of food from the esophagus to the stomach by increasing the intrathoracic and intraesophageal pressure. If this is successful and food enters the stomach, dysphagia and the feeling of fullness immediately disappear.

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Pain in the lower and middle third of the sternum

Retrosternal pain is caused by overstretching of the esophagus and extra-swallowing movements of the esophagus. The pain radiates to the neck, jaw, interscapular region, and is associated with food intake. It is possible that severe pain may appear outside of food intake. This is usually associated with anxiety and psycho-emotional stress.

• May be associated with spasm of the esophageal muscles. In this case, pain is relieved by nitroglycerin, atropine, nifedipine.
• They occur when the esophagus is full and disappear after regurgitation or passage of food into the stomach.

Regurgitation

Regurgitation of food or mucus retained in the esophagus. With minor dilation of the esophagus, regurgitation occurs after several swallows. With significant dilation of the esophagus, regurgitation occurs less frequently, but the volume of regurgitated food is usually greater. When regurgitated, the contents of the esophagus may enter the respiratory tract.

Regurgitation usually occurs after the patient has eaten a sufficient amount of food. Forward bending of the body contributes to the occurrence of regurgitation. It also occurs at night (the "wet pillow symptom").

Weight loss

Weight loss is typical and often characterizes the severity of the disease. Weight loss often reaches 10, 20 kg and more.

Hiccups

Hiccups occur more frequently in patients with achalasia compared to patients with dysphagia due to other causes.

Congestive esophagitis

Congestive esophagitis develops as the disease progresses and is manifested by nausea, belching of rotten (stagnation and decomposition of food in the esophagus), air, food, increased salivation, and an unpleasant odor from the mouth.

The course of the disease is often progressive, with a gradual worsening of the symptoms of achalasia cardia, so that over time, not only solid food but also mushy food causes difficulties. The dilation of the esophagus increases, food stagnates. The esophagus holds 500-2000 ml of liquid and as a result of stagnation, esophagitis develops, the risk of squamous cell carcinoma of the esophagus increases. Pulmonary complications caused by aspirated contents are common. Sometimes the disease worsens in irregular attacks caused by excitement, intercurrent infections, etc.; between periods of deterioration, there may be various periods of rest with minimal complaints. Less often, significant dilation of the esophagus is determined in patients without previous pronounced dysphagic disorders.

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