The pathophysiology of the disease is unknown, therefore treatment mode can neither reverse nor prevent the neuro damage of the myenteric plexus.
The primary goal of management should focus on early diagnosis and prevention of late complications to preserve oesophagal structure and function.
Available treatment aims to relieve oesophageal outflow obstruction by lowering LES tone or disrupting the LES.
Pharmacologic treatments:
Smooth muscle relaxants
Medical management has been used to relax smooth muscles, decrease LES pressure, and give relief of symptoms, however, the effects are temporary clinically and produce aftereffects, however, the effects are limited clinically and produce side effects. Nitrates rise the NO concentration in smooth muscle cells, which lately increases cyclic guanosine monophosphate levels and leads to muscle relaxation. Calcium is necessary for oesophageal muscle contractions and calcium antagonists block its action.
These therapies are now reserved for short-term treatments in patients who cannot tolerate invasive methods or as a bridge to more definitive treatment.
Botulinum Toxins:
Endoscopic botulinum toxin injection is still an obtained method for symptom relief, however, the effects are temporary. As with oral medications, Botox injections should be saved for patients who are unable to get more invasive methods.
Botulinum toxin is a potent restraint of the acetylcholine release from nerve endings. The Clostridium botulinum bacteria combine the latent form. Botox cleaves Synaptosomal- Associated Protein (SNAP-25), a cytoplasmic protein involved in the binding of acetylcholine-containing presymptomatic vesicles with the neuronal plasma membrane. Exocytosis of acetylcholine is obstructed and paralysis of the innervated muscle occurs. Botox prevents the unanimous stimulation of the LES by cholinergic neurons, helping to put back the LES to a lower resting pressure. Usually, botox injections lower the LES pressure by 50%, while partly better the oesophagal emptying.
Based on numerous studies, some placebo-controlled, botox markedly improves symptoms in approximately 75% of patients. However, symptoms may reappear again in more than 50% of patients after some time possibly because of the regeneration of the affected receptors.
Endoscopic pneumatic balloon dilatation:
The dependence of recent achalasia operations focuses on dismembering the LES by interventional means. Endoscopic pneumatic balloon dilatation (PD) positions a balloon beyond the LES and expands it, effectively rupturing the muscle of the affected segment. Curvaceous dilation has the advantage of being an inpatient procedure, the pain is minimum, GERD is an occasional problem, and curvaceous dilation can be performed in any age group and during gestation.
Graded PD is performed by an initial dilation of 3.0cm, progressing slowly at 0.50 cm intervals to reach a target of 4.0 cm. This is accomplished periodically with 4-6 weeks between each dilation.
Peroral Endoscopic myotomy(POEM):-
Peroral Endoscopic myotomy is one of the most recent advanced treatments of achalasia.
Mucosal incision, submucosal tunnel creation, myotomy of oesophagal circular muscle, and closure of mucosal incision are the principal four steps of performing POEM.
General anaesthesia with endotracheal intubation and carbon dioxide insufflation is used for the procedure.
The frequency of raised acid exposure, influx oesophagitis, and GERD symptoms after POEM ranges from 13- 58, 18- 65, and 17- 40 independently.So patient should be counselled for increased risk of GERD post POEM. However, most GERD after myotomy are mild and asymptomatic, and proton pump inhibitors cause decreased production of stomach acid.
Homoeopathic treatment:
Achalasia cardia is a rare disorder that causes difficulty in passing food from the oesophagus into the stomach. As homoeopathic treatment is a holistic approach where medicines are prescribed based on individualization and symptoms similarity.
Symptoms of achalasia cardia like dysphagia, vomiting, heartburn and oesophageal spasms can be managed by homoeopathic treatment.
Several medicines can cure achalasia cardia according to the similarity of the symptoms, cause and modalities etc.
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