Diagnostics and treatment of cardiac achalasia and cardiospasm: guidelines of the Russian gastroenterological association

Aim of review. To present clinical guidelines of the Russian gastroenterological association on management of cardiac achalasia and cardiospasm to practical doctors. Summary. Cardiac achalasia is primary esophageal motor function disorder manifested by impaired lower esophageal sphincter relaxation and defects of thoracic esophagus peristalsis. Etiology of the disease remains unknown. Three main hypotheses of disease etiology are discussed: genetic, contagious and autoimmune. Clinical symptoms of disease: difficulty of passage of solid and liquid food through the esophagus, vomiting, in certain cases - chest pain; severe disease is accompanied by cough and weight loss. Differential diagnosis is carried out with cardioesophageal cancer, peptic stricture, esophageal webs and rings, neurogenic anorexia and coronary heart disease in the cases with chest pain. Barium meal study reveals dilation and deformity of the esophagus, coneshaped narrowing in the lower esophageal sphincter area, retention of barium contrast in the esophagus, absence of stomach gas bubble. Endoscopy discloses dilation and deviation of esophageal lumen, presence of food remnants, liquids and mucus, uniform opening of cardia at air insufflation and capability of passage of endoscope into the stomach. «The gold standard» of investigation of patients with suspected achalasia is manometry. Clinical guidelines for the first time in Russian literature presents the latest approaches to cardiac achalasia diagnosis by high resolution esophageal manometry with application of modern Chicago classification. This classification defines three types of cardiac achalasia, and its usage provides significant increase of treatment prognosis accuracy. Clinical guidelines contain the detailed description of all up-to-date treatment methods for cardiac achalasia and cardiospasm (conservative, endoscopic, surgical) aimed to dilation of cardia and decrease of its pressure to improve of passage of food through area of gastroesophageal junction. Disease prognosis at timely diagnosis and treatment is favorable; remission rate for 10 years post-pneumocardiodilation ranges 75 to 90%. However patients require constant outpatient monitoring due to esophageal cancer risk (3 to 8% of cases). Conclusion. Clinical guidelines contain complete modern information, essential for the practical doctor on diagnosis and treatment of cardiac achalasia and cardiospasm.