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Cardia Insufficiency: Causes, Symptoms and Treatment
Cardia insufficiency refers to the incomplete closure of the lower esophageal sphincter. Stomach acid can flow back into the esophagus, causing irritation and discomfort.
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Cardia insufficiency refers to the incomplete closure of the lower esophageal sphincter. Stomach acid can flow back into the esophagus, causing irritation and discomfort.
What is Cardia Insufficiency?
Cardia insufficiency describes the weakening or incomplete closure of the lower esophageal sphincter (LES), the muscular ring located at the junction between the esophagus and the stomach. Under normal conditions, this sphincter prevents the backflow of stomach contents into the esophagus. When it fails to close properly, gastric acid and digestive fluids can reflux upward, irritating or damaging the sensitive lining of the esophagus.
Causes
Cardia insufficiency can result from a range of factors:
- Hiatal hernia: Part of the stomach protrudes through the diaphragm into the chest cavity, impairing sphincter function.
- Obesity: Increased abdominal pressure puts strain on the lower esophageal sphincter.
- Pregnancy: Hormonal changes and the growing uterus raise intra-abdominal pressure.
- Dietary triggers: Caffeine, alcohol, fatty foods, chocolate, and nicotine can reduce sphincter tone.
- Medications: Certain drugs such as calcium channel blockers or anticholinergics may relax the sphincter muscle.
- Connective tissue weakness: Congenital or acquired weakness of connective tissue can impair sphincter function.
Symptoms
Common symptoms of cardia insufficiency include:
- Heartburn: A burning sensation behind the breastbone, often after meals or when lying down.
- Acid regurgitation: Backflow of stomach contents into the throat or mouth.
- Difficulty swallowing (dysphagia) in cases of advanced esophageal damage.
- Chest pain, which must be distinguished from cardiac causes.
- Chronic cough or hoarseness caused by rising stomach acid.
- Globus sensation: A feeling of a lump in the throat.
Diagnosis
The diagnosis of cardia insufficiency is established through several investigations:
- Esophagogastroduodenoscopy (EGD): Direct visualization of the esophageal lining and sphincter to detect inflammation, erosions, or mucosal damage.
- 24-hour pH monitoring: Continuous measurement of acid levels in the esophagus to quantify reflux episodes.
- Esophageal manometry: Assessment of sphincter pressure and esophageal motility.
- Barium swallow X-ray: Imaging of the swallowing process and detection of reflux.
Treatment
Lifestyle Modifications
In many cases, lifestyle adjustments can significantly reduce symptoms:
- Weight loss in overweight individuals
- Sleeping with the head and upper body elevated
- Avoiding alcohol, nicotine, and caffeinated beverages
- Avoiding fatty, spicy, or acidic foods
- Eating smaller, more frequent meals
- Not lying down immediately after eating
Medication
To reduce gastric acid production and relieve heartburn, the following medications are commonly used:
- Proton pump inhibitors (PPIs) such as omeprazole or pantoprazole – the most effective agents for suppressing acid production.
- H2 receptor antagonists (e.g., ranitidine) – less potent than PPIs, suitable for milder cases.
- Antacids – for short-term neutralization of stomach acid.
- Prokinetics – promote gastric emptying and may improve sphincter tone.
Surgical Treatment
In cases of severe cardia insufficiency or failure of conservative therapy, surgical intervention may be required. The most common procedure is laparoscopic fundoplication, in which part of the stomach is wrapped around the lower esophagus to reinforce the sphincter.
References
- Kahrilas P.J. - Gastroesophageal Reflux Disease, New England Journal of Medicine, 2008; 359(16):1700-1707.
- Dent J. et al. - Epidemiology of gastro-oesophageal reflux disease: a systematic review, Gut, 2005; 54(5):710-717.
- Katz P.O. et al. - ACG Clinical Guideline: Diagnosis and Management of Gastroesophageal Reflux Disease, American Journal of Gastroenterology, 2022; 117(1):27-56.
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