Ian S
Thinks s/he gets paid by the post
the bad news is it's a rare swallowing disorder. Yesterday, I had a telehealth meeting with my gastroenterologist who provided the results of a High Resolution Manometry test I had done earlier in the week at a large hospital in Phoenix. I have achalasia, type II to be specific. Diagnosis, in addition to the manometry involved endoscopy, and a barium swallow test. The manometry was unpleasant: a long tube with many pressure sensors along its length is inserted up through the nose, down the throat and esophagus into the stomach. There is no sedation as you must be fully awake to do a series of swallows of salt water and the pressure profiles are recorded.
The symptoms of the disorder include problems swallowing food including liquids: at times it feels like the food is sticking in your esophagus. In actuality, it really is! In the type II version that I have, the sphincter muscle between the stomach and the esophagus does not relax properly to allow food to pass through. In my case, the symptoms are not yet as bad as some who are simply unable to get any food to stay down and wind up losing weight fast, eventually requiring a feeding tube and surgery or other treatment. I have trouble but if I eat slowly, chew well, and use room temperature water to help, food almost always goes down. Still it's problematic because, the disorder is generally progressive. The cause is unknown and there is no cure. Apparently, the nerves controlling the sphincter get damaged and there is no resurrecting them.
Fortunately, there are treatments that amount to weakening the sphincter enough to allow food to pass through. Botox treatments are fairly easy but short lived. Pneumatic dilatation using a rapidly expanding balloon to stretch the sphincter thus weakening it works for longer but has risks of esophageal perforation. The gold standard is laparoscopic surgery that cuts the sphincter muscle to weaken it using a series of holes in the abdomen for the surgucal instruments. The results can last for many years. The newest procedure is called POEM where the sphincter muscle is cut from the inside using a surgical instrument at the tip of an endoscope. The latter results in a faster recovery with less pain, no scars and lasts for years but it remains to be seen if it holds up quite as well as the gold standard surgery.
My gastroenterologist has referred me to a specialist who does the POEM procedure but there are advantages to the laparoscopic method that I need to explore.
Since the incidence is only about 1 in 100,000 people, I'm not sure if anyone here has had the problem but if you have, I'd be interested to hear how your treatment has worked out. In any event, since a lot of patients get it at a younger age, it doesn't seem to be an old folks' disease. Who knows, maybe the treatment I get will last the rest of my life!
The symptoms of the disorder include problems swallowing food including liquids: at times it feels like the food is sticking in your esophagus. In actuality, it really is! In the type II version that I have, the sphincter muscle between the stomach and the esophagus does not relax properly to allow food to pass through. In my case, the symptoms are not yet as bad as some who are simply unable to get any food to stay down and wind up losing weight fast, eventually requiring a feeding tube and surgery or other treatment. I have trouble but if I eat slowly, chew well, and use room temperature water to help, food almost always goes down. Still it's problematic because, the disorder is generally progressive. The cause is unknown and there is no cure. Apparently, the nerves controlling the sphincter get damaged and there is no resurrecting them.
Fortunately, there are treatments that amount to weakening the sphincter enough to allow food to pass through. Botox treatments are fairly easy but short lived. Pneumatic dilatation using a rapidly expanding balloon to stretch the sphincter thus weakening it works for longer but has risks of esophageal perforation. The gold standard is laparoscopic surgery that cuts the sphincter muscle to weaken it using a series of holes in the abdomen for the surgucal instruments. The results can last for many years. The newest procedure is called POEM where the sphincter muscle is cut from the inside using a surgical instrument at the tip of an endoscope. The latter results in a faster recovery with less pain, no scars and lasts for years but it remains to be seen if it holds up quite as well as the gold standard surgery.
My gastroenterologist has referred me to a specialist who does the POEM procedure but there are advantages to the laparoscopic method that I need to explore.
Since the incidence is only about 1 in 100,000 people, I'm not sure if anyone here has had the problem but if you have, I'd be interested to hear how your treatment has worked out. In any event, since a lot of patients get it at a younger age, it doesn't seem to be an old folks' disease. Who knows, maybe the treatment I get will last the rest of my life!
