Management Strategies of Achalasia Cardia: A Study in Tertiary Care Hospitals

Abstract

Background: Achalasia cardia is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and absent peristalsis, leading to progressive dysphagia, regurgitation, and weight loss. This study evaluates different management strategies for achalasia, comparing their efficacy and outcomes. Methods: This retrospective study was conducted from January 2004 to December 2009 at Bangabandhu Sheikh Mujib Medical University (BSMMU) and private hospitals in Dhaka. A total of 59 patients with diagnosed achalasia cardia were included. Patients were managed using medical therapy (nitrates, calcium channel blockers), pneumatic dilatation, laparotomy cardiomyotomy, or laparoscopic cardiomyotomy. Clinical presentation, treatment outcomes, complications, and recurrence rates were analyzed using SPSS. Results: Dysphagia and regurgitation were the commonest symptoms. Pneumatic dilatation provided symptomatic relief but had a high recurrence rate (45.0%). Surgical interventions, particularly laparoscopic cardiomyotomy, demonstrated superior long-term outcomes, with 75.0% of patients achieving satisfactory results. Laparoscopic cardiomyotomy was associated with shorter operative time (1.5 ± 0.6 hours vs. 2.1 ± 0.8 hours, p<0.05), earlier oral feeding (1.3 ± 0.9 days vs. 2.4 ± 1.1 days, p<0.05), and reduced hospital stay (3.3 ± 0.8 days vs. 5.8 ± 2.3 days, p<0.05) compared to laparotomy. Postoperative complications, including reflux and wound infections, were more frequent in the laparotomy group. Conclusion: Laparoscopic cardiomyotomy is the preferred surgical option for achalasia due to its favorable outcomes, including reduced complications, shorter hospital stays, and faster recovery. Pneumatic dilatation remains a viable non-surgical option but requires repeated procedures due to recurrence. Further studies are needed to refine treatment protocols and optimize patient outcomes.