Achalasia of the cardia

The correct Option is a) dysphagia is more marked for solids than fluids

Achalasia of the cardia is a functional failure of relaxation of the lower oesophageal sphincter. Histological examination shows degeneration of the ganglion cells in the myenteric plexus and changes within the Vagus nerves. Lymphocytic infiltration is often seen with fibrosis occurring in chromic cases. The aetiology is unknown although infection with a neurotropic virus affecting the autonomic nervous system has been suggested.

The commonest clinical presentation is with insidious onset of dysphagia with patients often having symptoms for several years before seeking medical advice. This is in contrast to the symptoms of oesophageal cancer where the symptoms progress over weeks and months. Dysphagia occurs with both solids and fluids often helping in differentiating it from mechanical obstruction where symptoms occur with solids before fluids.

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