The esophagus is described as a muscular tube that serves as a passageway for liquids and foods from the pharynx to the stomach. Cardiospasm represents a disorder of motor function located at the distal end of the esophagus resulting in failure of the stomach (cardia) to relax.

A malfunction of the nerve supply to the esophageal muscle results in impairment of esophageal peristalsis.

The onset of symptoms of the condition is slow, but progressive. Dysphagia of both solids and liquids is the primary symptom. Other manifestations include regurgitation, night cough, and chest pain. Aspiration is possible, in association with formation of lung abscess or pneumonia.

Barium x-rays demonstrate an absence of peristalsis during swallowing. Use of an esophagoscope shows dilation but no lesion obstructing the cardia. If there is an obstruction, cancer should be ruled out by a biopsy.

The goal of treatment is to reduce the lower esophageal pressure. A bougie is used initially to achieve this. Repeated dilations may be required. Surgery to sever the muscle fibers in the lower esophageal sphincter may be done to release those fibers that do not respond to dilation. The use of botulinum toxin injections into the lower esophageal sphincter to destroy the cholinergic nerve supply has been successful in 80% of patients.

There is a controversial point being made that esophageal cancer is increased in people with achalasia (cardiospasm).

• None.

Notes

• If not amenable to dilation, rate as for the degree of obstruction (stricture).