Acid Reflux -- Esophageal Spasms
Gastroesophageal Reflux Disease (GERD, Acid Reflux)
Acid-Alkaline Balance by Karl Loren
Dr. Weston Price -- On Acid -- Alkaline Balance
Achalasia is a rare disease of the muscle of the esophagus
Mass Near The Esophagus -- Cancer? Benign?
This Page:
Achalasia: Answers to Frequently Asked Questions
Achalasia is a rare disease of the muscle
How about YOUR question here?
Read below or choose another question.
Source
Achalasia: Answers to Frequently Asked Questions
What is the definition of achalasia?
Lay: Achalasia is a disorder of swallowing resulting from the inability of the muscle of the esophagus (food pipe) to relax, preventing food and liquids to get to the stomach. The muscle affected is called the lower esophageal sphincter: this is a ring of muscle at the junction of the esophagus and stomach, which normally stays shut (to prevent stomach acid from coming back) and opens during swallowing to allow food down. In patients with achalasia, this ring stays shut. In addition, the rest of the esophagus loses its ability to pump material down (a process called peristalsis). This combination of defects results in great difficulty in swallowing.
Scientific: Achalasia is a disorder of the esophagus characterized by failure of the lower esophageal sphincter (LES) to relax and aperistalsis of the esophageal body.
Are there different types of achalasia?
Achalasia can very rarely occur from other disease states (such as cancer), when it is known as secondary achalasia or pseudoachalasia. However, by far the commonest type is primary achalasia which implies that the disease originates in the esophagus itself. This is the type that is commonly implied when the term achalasia is used without qualification. Another common adjective used for this kind of achalasia is "idiopathic" which means that we do not know what causes this disorder. Finally, primary achalasia can also be classified as "classic" (in which there is virtually no contraction seen in the body of the esophagus) or "vigorous" (in which there is activity in the body of the esophagus but this is largely ineffective "spasm" rather than true coordinated pump-like activity or peristalsis).
What percentage of the population has it?
Achalasia is a relatively uncommon disorder of esophageal motility with a prevalence estimated at about 10 in 10,000 and an incidence rate in the range of 0.5 new cases per year per 100,000 population.
What is the age distribution?
Although achalasia has also been described in very young children and the very old, it is uncommon before the age of 25, with a clear-cut age-related increase thereafter. Most commonly the disease occurs in middle adult life (30-60 years of age) and affects both sexes and all races nearly equally.
What causes it?
Theoretically, achalasia could result from a problem in the swallowing center in the brain, the (vagus) nerves that carry impulses from that center to the esophagus or within the nerve cells residing in the esophagus itself. There is good evidence to suggest that the major problem lies in the nerve cells of the esophagus. These nerves are of two broad types: those that cause the sphincter (or other muscle) to relax or open up and those that cause it contract or tighten up. Normally, the sphincter muscle is in a state of balance between these two opposing sets of nerves. In achalasia, most of the nerves responsible for relaxation are lost, resulting in a shift in the balance towards contraction- hence, the failure of the LES to relax or open up with swallowing.
What are the symptoms of achalasia?
The major symptoms of achalasia are difficulty in swallowing (dysphagia) and bringing back material from the esophagus (regurgitation). The difficulty in swallowing usually involves both liquids and solids from the onset and is often felt as an obstruction to passage of material in the lower chest. Regurgitation of food can occur spontaneously but particularly when the patient is lying down or bends over. It can occasionally be associated with spells of coughing or even pneumonia if the regurgitated material goes down the airways. The third common symptom is chest pain: this can be associated with swallowing but often occurs spontaneously. The chest pain can be severe or mild. Finally, some patients will also complain of "heartburn", although this is relatively rare.
It is not surprising that patients will lose weight and run the risk of becoming significantly malnourished.
How is it diagnosed?
Although achalasia can be suspected on the basis of clinical history alone, patients usually undergo a series of tests to confirm the diagnosis. These are as follows:
Can I die from achalasia by choking to death?
Theoretically patients can have pieces of food and liquids go down the airways, resulting in severe difficulty in breathing. However, the chances of this causing death are very unlikely. Most often when this occurs, patients will complain of coughing at night or develop pneumonia. This does not happen very often these days because of earlier medical attention.
What are the long term effects of living with Achalasia?
The long term effects of untreated achalasia are poor nutrition with its consequences and a small risk of developing cancer of the esophagus.
Will achalasia reverse itself and disappear after a period of time?
Achalasia does not reverse itself spontaneously.
Tips and tricks of dealing with achalasia.
What are the types of treatment and the pros and cons of each?
Achalasia is not a curable disease yet. However, there are a variety of treatments available that can effectively relieve symptoms and help patients resume a relatively normal lifestyle. The most important cause of symptoms in achalasia appears to be the lower esophageal sphincter- this is a ring of muscle at the junction of the esophagus and the stomach that normally opens with swallowing to allow material to pass into the stomach. In achalasia, this muscle stays shut and therefore causes food to get held up and eventually start backing up into the throat.
All present therapies for achalasia seek to lower the pressure in this ring of muscle, thereby overcoming the resistance to the passage of food (see figure). This can be done by one of the following means:
1. Traditional drugs: these act directly on the muscle, causing it to relax. Examples include nitroglycerin (also used for heart problems) and nifedipine.
2. Balloon (also known as pneumatic) dilation. This involves the insertion of a large balloon into the esophagus at the time of endoscopy. The balloon is positioned across the LES and then inflated quickly with the aim of causing a controlled tear of the muscle. This is usually an outpatient procedure.
3. Surgery (myotomy). This involves exposing the LES surgically and then cutting the muscle directly. In the past, this involved a major operation but nowadays is increasingly being done via "key-hole" surgery (laparascopic or videoscopic myotomy) with much reduced discomfort and length of stay.
4. Botulinum toxin injection. This is also an
endoscopic procedure and requires the injection of this drug (botulinum toxin)
into the LES. The toxin causes the muscle to be partially paralyzed.
Questions And Answers About Treatment
No treatment method has clear cut superiority over others in all aspects.
The long-term results (beyond 10 years) are hard to predict with any means of
treatment.
Questions Patients Should Ask The
Physician
What is the short term effectiveness of treatments?
| Overall | > 40-50 years of age | < 40-50 years of age | |
| Dilation | 70% | 70-80% | 30-40% |
| BoTx | 70% | 80% | 40% |
| Surgery | 80-90% | 80-90% | 80-90% |
What immediate adverse effects can I expect?
What will it take to get me through the next five years?
What about after the first 5 years?
Questions The Physician Should Ask
You
Do you want the single most permanent method of palliation and are willing to be hospitalized for a few days with moderate discomfort?
Do you want the next most permanent method of palliation and are willing to take the small risk of perforation ?
Do you want the most innocuous procedure that provides effective relief but are willing to undergo a 15 minute endoscopic procedure every year, with the understanding that the long-term consequences are not fully known?
| Note: The information on
this page should not substitute the need for a full evaluation/discussion
with your physician. A gastroenterologist is recommended.
Also, Botox is not yet approved by the FDA. |
|
Send me your comments, or your own question to be answered. Only two fields are required, but you are cordially invited to fill in all the others also.
|
I promise to answer your message -- click here to send me a personal message
|
SUBSCRIBE: The Wednesday Letter is a free electronic monthly newsletter written and published by Karl Loren. You can view more than 50 back issues of this publication by clicking here. The Wednesday Letter subscription list is maintained on a secure server, no name is ever given or sold to anyone, and it is never used except for this Newsletter. It is automatically published on the Tuesday night just before the first Wednesday of every month. You can subscribe to this free monthly electronic letter by entering your eMail address and name below. You will then automatically receive a request for confirmation, sent to whatever address you have entered. If you do NOT receive this confirmation request, then you will not be subscribed. There may have been an error with your address and you should resubmit. The letter is never sent twice to the same address -- so you do not have to worry about a duplicate subscription. When you receive this confirmation request you must reply to it, or your subscription will not become active. No one can subscribe your name, and address, without you being notified, and if you get an unwanted notice of subscription you only need to DO NOTHING and the subscription will NOT be active.
REMOVAL: You can remove yourself from the subscription list in several different ways. Click here to read about this entire newsletter system. Every edition of The Wednesday Letter is delivered to your address with YOUR name and address in view on the letter, with a link that allows you to remove THAT name from the subscription list. If you try to send this removal message from an address different from the one you used to send in your original confirmation, then you will get a warning notice first, sent to the subscription address, asking you to confirm that you want to be removed from the list -- by replying to THAT request for confirmation, you will then be automatically removed. Thus, no one else can unsubscribe you, from some other computer, without your knowledge. But, if you send in the unsubscribe notice from the same machine used to receive the Letter, then the removal from the subscription list is automatic.
Personal Message: When you send a personal message to Karl Loren, you will receive a personal reply as per his instructions. Karl pledges that every personal message will get a personal answer. When you provide your mail address, we will send you free information including our free catalog and a cassette tape lecture by Karl Loren about heart disease, no charge, by mail, even if outside the US. You can select particular information you would like to receive, along with the free cassette tape and catalog.
You can reach Vibrant Life in many ways, including by mail to Vibrant Life, 2808 N. Naomi St., Burbank, CA 91504. Within the US and Canada, use the toll free number: (800) 523-4521, the local number: (818) 558-1799, the FAX: (818) 558-7299, eMail to kimberly@oralchelation.com or any one of the hundreds of message forms throughout the 50 web sites. Vibrant Life normally ships the same day we get an order. There are message forms on each of the 100,000+ pages on this and other sites where you can communicate with Vibrant Life. Check out our companion site, at: http://www.oralchelation.net where Karl's 2000 page book is published. Karl Loren is the author and webmaster for this BOOK, as well as for another web site about ORAL CHELATION. His personal philosophical articles are at PHILOSOPHY.
Copyright © May 20, 2008 6:23 AM by Karl Loren on behalf of Vibrant Life, ALL RIGHTS RESERVED. Permission is granted for non-commercial downloading, copying, distribution or redistribution on two conditions: One, that some form of copyright notice is included in every copy distributed or copied, showing the copyright belonging to Vibrant Life, Burbank, CA, at www.oralchelation.com . The second condition is that the material is not to be used for any purpose contrary to the purposes and objectives of this site. This permission does not extend to materials on this site which are copyrighted by others.
