Methods to treat cardiac spasms

The article is professionally consulted by Gastroenterologist - Department of Examination & Internal Medicine - Vinmec Hai Phong International General Hospital

Achalasia is a rare disease of the esophagus characterized by esophageal dysfunction. The terminal portion of the esophagus that enters the stomach is constricted and narrowed, while the upper portion is dilated.

Cardiac spasm is a neuromotor disorder of the esophagus characterized by decreased esophageal motility and decreased relaxation of the lower esophageal sphincter during swallowing.
The disease occurs in both men and women with the same rate. However, the disease is most common in the 25-60 age group. The incidence is 1.6 per 100,000 population per year in the United States.

Cardiac spasm is caused by progressive degeneration of ganglion cells in the esophageal plexus in the esophageal wall, resulting in an inability to relax the lower esophageal sphincter, accompanied by a distal loss of peristalsis.
The etiology of ganglion cell degeneration is still unclear, it may be due to protozoan infection or autoimmune causes, some types of tumors can also cause achalasia due to direct compression. or due to paraneoplastic syndromes.

Difficulty swallowing both solid and liquid foods. Vomiting may occur immediately after eating. After a long illness, the esophagus dilates, vomiting often appears late after eating. Reflux: May appear immediately after eating or many hours after eating. Chest pain: Pain behind the sternum, often painful when swallowing. He lost a lot of weight because the patient could not eat.

Esophageal X-ray with oral contrast is a valuable diagnostic method in the typical case of dilated esophagus with a lot of food and fluid, loss of motility, narrowing of the cardia, and the appearance of a bird's beak. Esophagogastroduodenoscopy: there is still food in the esophagus, abnormally increased resistance when the scope is passed through the junction of the stomach and esophagus. Endoscopy helps to rule out esophageal cancer, stomach and esophageal stricture. Esophageal manometry: confirm the diagnosis.

Use drugs to treat cardiac spasms: For mild cases, isosorbide nitrate can be used 5-10mg sublingually before eating 10-15 minutes, calcium channel blockers are effective in relaxing the lower sphincter to help relieve pain. symptoms of difficulty swallowing. However, the drug only has a temporary effect in the early stages and has no effect later on. Short-acting nifedipine should be avoided because of the risk of adverse events including severe hypotension and ischemic complications. Using a balloon for dilatation (pneumatic dilatation): This is a popular method in the world. Airballs with different diameters: 3; 3.5 and 4cm. Balloon pressure when dilating: 6-12 PSI, can be dilated 1-3 times. This measure can cause complications: bleeding, perforation of the esophagus. Botulinum toxin injection into the lower esophageal sphincter: this method works well, but the results only last about 6 months.

Lower esophageal sphincterotomy: This procedure cuts off the lower esophageal sphincter to relieve lower sphincter pressure. This surgery today is mainly performed by laparoscopic and oral endoscopic (POEM) surgery. Most patients after laparoscopic lower sphincterectomy have symptoms of reflux. The anti-reflux process can be done by many methods such as Dor, Toupet, Nissan... to restore the anti-reflux barrier and relieve symptoms after surgery. With POEM lower esophageal sphincterotomy, only the sphincter is removed, there is no anti-reflux progression. The success rate of the method can be >90%.

The cause of the disease is not clear, there are no known risk factors to avoid. However, early treatment can help prevent complications. When you have symptoms, it is necessary to immediately go to reputable medical facilities for examination and treatment as soon as possible.