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Achalasia, Had Hellermyotomy, Balloon Dilation, Botox, Difficulty In Swallowing. Treatment?
I have achalasia and I have had hellermyotomy, balloon dilation, botox, etc and nothing seems to work. Swallowing is still difficult. I have gone to over six doctors and none seems to help me. The last doctor told me that I had too much scarring that he would not do the heller myotomy again. I have lost over 80 pounds gone from 200 lbs to 106 pounds. I am afraid that I am going to melt away and die. Is there anything else that can be done?
Tue, 8 Oct 2013
Balloon dilatation through Endoscope of oesophagus can be continued with liquids and semisolids as well as some prokinetic drug like Metaclopamide daily before food should be performed for a few months.Good relaxation with Alprozolam at bed time may improve the situation.
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1. Botox injections cause scarring in the sphincter which has increased the difficulty for Heller myotomy now [as suggested by your last doctor]
2. Ballon dilatation also causes scarring, which again causes difficulty with heller myotomy surgery, plus it also causes GERD (gastro esophageal reflux disease) causing exacerbation of symptoms.
3. Even after successful treatment of achalasia, swallowing may still deteriorate over time [as in your case]. THUS
i. The esophagus should be checked every year or two with a barium swallow because some may need esophagectomy after many years.
ii. Some physicians recommend pH testing and endoscopy to check for reflux damage, which may lead to a premalignant condition known as Barrett's esophagus or a stricture if untreated.
iii. Life style changes has to be incorporated in your daily routine
. eat slowly, chew well, drink plenty of water with meals, and avoid eating near bedtime.
. Raise the head of the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity.
. avoid foods that can aggravate reflux:citrus fruits, chocolate, alcohol, and caffeine.
1. Botox injections cause scarring in the sphincter which has increased the difficulty for Heller myotomy now [as suggested by your last doctor]
2. Ballon dilatation also causes scarring, which again causes difficulty with heller myotomy surgery, plus it also causes GERD (gastro esophageal reflux disease) causing exacerbation of symptoms.
3. Even after successful treatment of achalasia, swallowing may still deteriorate over time [as in your case]. THUS
i. The esophagus should be checked every year or two with a barium swallow because some may need esophagectomy after many years.
ii. Some physicians recommend pH testing and endoscopy to check for reflux damage, which may lead to a premalignant condition known as Barrett's esophagus or a stricture if untreated.
iii. Life style changes has to be incorporated in your daily routine
. eat slowly, chew well, drink plenty of water with meals, and avoid eating near bedtime.
. Raise the head of the bed or sleeping with a wedge pillow promotes emptying of the esophagus by gravity.
. avoid foods that can aggravate reflux:citrus fruits, chocolate, alcohol, and caffeine.
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