If, with a delay in the passage of food, the patient continues to eat, severe pain behind the sternum, regurgitation and autonomic disorders, up to fainting, may occur.
If, with a delay in the passage of food, the patient continues to eat, severe pain behind the sternum, regurgitation and autonomic disorders, up to fainting, may occur.
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- Quite often, with achalasia of the cardia, there is regurgitation without the admixture of acidic gastric contents or abundant salivation.
- Regurgitation appears during meals, after it and at night, sometimes when the torso is tilted or in the supine position.
- Many patients with significant esophageal dilation (type 2 achalasia cardia) experience nocturnal regurgitation.
- In this case, there is a risk of infection of the respiratory tract and asphyxia. Some patients avoid eating shortly before bed or flush the esophagus at bedtime.
Attacks of shortness of breath, coughing, or snoring at night may be due to overflow of the distended esophagus with food or liquid and their flow into the airways. Repeated aspirations can lead to chronic lung disease, pulmonary suppuration, and even death due to asphyxia.
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The burning pain associated with esophagitis is severe and relieved by 1-2 sips of water. Pressing pain depends on the stretching of the walls of the esophagus by the food lump lingering in it and disappears after emptying the esophagus into the stomach or through the mouth. Spasmodic pain associated with spasm of Diamox pills, localized behind the sternum, can radiate to the neck, throat, lower jaw, spine, shoulder girdle. They do not depend on food intake, are relieved by antispastic drugs, in particular nitroglycerin, sometimes by taking a small amount of food.
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Chest pain is not considered a permanent manifestation of achalasia cardia. At the same time, O. D. Fedorova noted them in almost 80% of patients. She describes three types of retrosternal pain: burning, pressing and spasmodic.
In some patients, spastic pains remain after cardiodilatation. Spontaneous pain behind the sternum is often tried to be explained by coronary heart disease, diseases of the stomach, liver, ortree paths. Physical examination in advanced cases reveals weight loss and, occasionally, mediastinal dullness with a full esophagus. It is useful to investigate the transit time of fluid from the oral cavity to the stomach. Normally, noises during swallowing appear over the projection of the stomach after 8-10 s; with achalasia, the appearance of noise is late, and sometimes they are not heard at all. This test can be difficult to evaluate.
Similar spontaneous pains, which often occur with type 1 achalasia of the cardia, may precede dysphagia. They often appear at night, are very strong and last from several minutes to several hours. The course of the disease is progressive, although some patients adapt for a long time to pushing food into the stomach.
Achalasia cardia may be suspected clinically. X-ray examination plays a decisive role in the diagnosis in most cases. In the later stages of the disease, on a plain radiograph on the right mediastinally, a shadow of the dilated esophagus may be detected, which is sometimes mistaken for a mediastinal tumor or paramediastinal effusion pleurisy. Known diagnostic value may be the absence of a gas bubble of the stomach.