Abstract

P. Keerthi*, J. Sudharshan*, P. Nagajyothi and G. Sai Prathyusha

ABSTRACT

Achalasia cardia is characterized by incomplete relaxation of the lower esophageal sphincter and esophageal nonperistaltic contraction The common symptoms included are heart burn, regurgitation, dysphagia,and weight loss A female patient of age 45 years was admitted in the hospital with chief complaints of dysphagia since 4 years, abdominal discomfort,epigastric burning sensation,nausea and vomiting . The patient had to drink a lot of water to help swallow solid or soft food. Complaint worsened from last one month followed by epigastric burning sensation,nausea and vomiting. The patient had a history of weight loss but no anorexia, no prior history of corrosive ingestion. The patient was known type-2 diabetic on treatment. Physical examination revealed no abnormality. Oesophageal manometry report reveals that basalEGJ pressure normal,EGJ relaxation incomplete. The basal LES pressure is normal with incomplete relaxation on swallowing. On 5ml wet swallows normal esophageal peristalitic wave is absent with pan-esophageal pressurization in >20% of swallows median IRP is more than 15mm Hg .Based on the results of the exams, we concluded the diagnosis as Achalasia Cardia type-II. The patient was under gone for surgery (heller myotomy) treated with calcium channel blocker and proton pump inhibitor. As she is diabetic treated with H actrapid human insulin The patient showed clinical improvement after medical procedure and was discharged. The patient was planned for twice a month follow up in the outpatient clinic.