Cardiospasm

" Cardiospasm " is a rare condition of the oesophagus, giving rise to its dilatation and to projectile regurgitant vomiting in many cases, and to dysphagia as well, in a few. Synonyms.?There are numerous terms used for this condition?viz., cardiospasm, hiatal cesophagismus, functional hiatal stenosis, preventriculosis, phrenospasm, etc. The one most commonly used is " cardiospasm." But unfortunately this is a misnomer. For (1) firstly, it is doubtful if there is true spasm at all in this disease; (2) secondly, the site of obstruction or spasm?whatever we may call it?is not at the cardia, but well above it, in the thoracic portion of the oesophagus; and (3) lastly, extensive dilatation of the thoracic portion of the oesophagus is a more marked feature of this disease than spasm. Further "spasm at the cardia" and "cardiospasm " are two quite distinct conditions. In spasm at the cardia" there is temporary and transient obstruction. In " cardiospasm" there is more prolonged obstruction and along with it diffuse dilatation. In spite of these differences there exists an inter-relationship between the two. Most observers consider spasm at the cardia as an early condition often preceding and frequently ending in the more chronic condition of cardiospasm. How is cardiospasm brought about? To understand this we must recall to mind a few physiological facts. Normally swallowing is a reflex act all throughout, except at the very beginning, when it is voluntary. The onward passage of a bolus of food through the oesophagus is brought about by the harmonious working ?f two sets of impulses?(1) one set passing