Essentials of Diagnosis
• Dysphagia, initially intermittent with food appar- ently sticking at the level of xiphoid cartilage, asso- ciated with retrosternal discomfort.
• Regurgitation immediately following ingestion and delayed regurgitation in chronic cases.
• Cough and dyspnoea due to pressure of dilated oesophagus on trachea and bronchi.
• Aspiration of material to tracheobronchial tree may cause bronchiectasis, lung abscess or pulmonary fibrosis.
• X-ray shows conical tapering of distal oesophagus and fluoroscopy shows ineffectual and purposeless peristalsis with dilatation.
-Anticholinergics to relieve spasm of oesophagus. Tab Probanthine or Buscopan, one tablet thrice daily 1⁄2 hour before meals.
-Nifedipine 10 mg thrice daily is beneficial.
2 Practical Standard Prescriber
-To avoid irritant substances like salicylates. NSAIDs. Alcohol, spicy food, gulping of food and swallowing unchewed food particles should be avoided.
-Avoid lying down for 2-3 hours after taking food.
-Oesophageal dilatation using pneumatic bag
under fluoroscopic guidance.
-Oesophago-cardio-myotomy may be required in a