Achalasia cardia and other benign lesions of the oesophagus as seen at Kenyatta National Hospital Between 1974 and 1988 - A clinicopathologic study.

Abstract

Achalasia cardia is an age old problem.The original description dates back to the 17th century.The basic pathology is a neuromuscular failure resulting in the absence of lower oesophageal sphincter relaxation in the face of an advancing bolus. Several workers have tried to locate the lesion in the neuro-muscular axis. Opinions differ as to the level though myenteric plexuses have been shown to have reduced, degenerate or absent ganglion cells. The clinical presentation is variable. The classical paradoxical dysphagia is not always seen. This variation not withstanding our treatment of choice has been the classical or modified Heller's oesophagomyotomy. During the period 1974 to 1987 a toal of 107 cases were seen at Kenyatta National Hospital. This gives an average of seven cases per year. The clinical presentation, methods of management and the outcome of treatment is the object of this work. Achalasia accounted for 43% benign lesion treated over the period under study. The male/female ratio was 1:1 contrary to other workers (2,40). The triad of dysphagia,regurgitation and weight loss were the only consistent symptoms. Other symptoms were described. In the absence of manometry Barium swallow and clinical evaluation still remained valuable diagnostic tools.Despite the advanced stage at which the patients presented the result of treatment was satisfactory. 63% had very good to excellent result at myotomy with pre or post operative dilatation. Evidence of carcinoma was found in 4 cases, accounts for 3.74%: 2 at endoscopic biopsy and two from resected lower oesophageal segments. Achalasia cardia is thus a not uncommon problem in our environment. Its malignant potential is unquestionable. Oesophagomyotomy is'so far the best treatment and should be performed as a primary therapy unless conditions warrant its postponement. We hope the aspects of the problem which have not been studied will form the basic of further work as soon as the facilities become available to us.