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Achalasia cardia: a review of 100 cases
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Achalasia cardia, a common esophageal obstruction in India, was studied in 100 patients. Surgical treatment, specifically a modified Heller
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Esophageal Diseases
Background:
- Achalasia cardia is the most frequent benign obstructive esophageal lesion in India.
- A review of 100 cases over 20 years represents the largest reported series from India.
- Observed unusual features include a male predominance (2.3:1) and affected children under 10.
Purpose of the Study:
- To review a large series of achalasia cardia cases from India.
- To analyze clinical features, diagnostic methods, and treatment outcomes.
- To evaluate the long-term efficacy of surgical intervention.
Main Methods:
- Retrospective review of 100 achalasia cardia cases over a 20-year period.
- Diagnostic evaluation included barium swallow X-ray studies.
- Surgical management involved a modified Heller's operation, primarily via a thoracic approach.
Main Results:
- Dysphagia for solids was the primary presenting symptom.
- Barium swallow X-ray was diagnostic.
- Long-term follow-up (19 years) of 65 patients showed excellent results in 76.9% and good results in 15.4%.
Conclusions:
- Modified Heller's operation, particularly with a thoracic approach, provides excellent long-term outcomes for achalasia cardia.
- Adequate myotomy is crucial for achieving favorable results.
- Recurrence or reflux esophagitis can lead to suboptimal outcomes.
Abstract:
Achaiasia cardia is the commonest benign obstructive lesion of the oesophagus in India. We have reviewed 100 cases over a 20-year period. This is the largest series that has been reported from India. Some unusual features were observed. Males were more often affected than females in a ratio of 2.3:1. Children below the age of 10 years are not often affected, but we had 10 subjects in this age group. In our series dysphagia for solids has been the main presenting feature. Barium swallow X-ray studies of the oesophagus were diagnostic. The treatment of choice had been surgical, and a modified Heller's operation has been the chosen procedure. Our preference is for the thoracic approach. Postoperative complications were few. Long-term follow-up of 65 patients over a 19-year period revealed excellent results in 50 patients (76.9%), good results in 10 (15.4%), and fair and poor results in two (3.1%) and three (4.6%) patients respectively. The fair and poor results occurred in patients with recurrence of symptoms or stricture formation due to reflux oesophagitis. The excellent results even on long-term follow-up, we believe are due to the adequate myotomy that was performed.