Western Diagnostic Techniques
There are three tests used to determine if the symptoms are Achalasia: barium swallow, manometry, and endoscopy. These tests are used to determine if the difficulty swallowing (Dyphagia) is due to Achalasia or from another possible disease (ie: esophagal cancer).
Severity of Achalasia can be scored objectively using the Eckardt Score, the Vantrappen Classification, and the Adams’s Stages. The Edkart score is the most useful for clinical evaluation The Edkart score ranges from 0 to 12, 12 being the worst symptoms [Gockel, 2007].
Barium swallow involves swallowing a chalky-white barium slurry in front of an X-Ray recording. Since barium is opaque to X-rays, the movement of the esophagus can be seen in real time. The barium slurry does not taste bad, but may make your poo chalky white. When I did the test a year and a half ago, the technician recognised there was something wrong immediately as the barium was not easily passing through the LES into my stomach. Only until I had drank a large amount, my LES would open and let the liquid into my stomach. I believe at that time I still had some parastalsis in my upper esophagus.
Manometry involves pushing a pressure sensitive tube about 2mm in diameter through your nose into your esophagus. They will ask you to swallow small sips of water, and the tube will measure the pressure along your esophagus. When I had my test, they lubed up the tube and put it in my nose. It is an extremely strange sensation as you continue to push it down. At certain point my gag reflex kicked in and I started dry heaving, but funny enough as it continues to go down the gagging will stop. The results were that I had no pressure change in my esophagus while swallowing; no parastalsis. My LES activated at a pressure of 25mmHg, which is pretty normal, however was incomplete relaxation (it only opened to 36%).
Endoscopy involves sedation and sticking a camera-tube down your throat. An IV needle was placed in my hand and I was told to count to 10. I think I go to about 3 before I don’t remember anything until waking up. This camera is used mainly to check that your esophagus doesn’t have any tumors which would obstruct food while swallowing. Mine was clear.
I “failed” all three tests and was thus diagnosed with classic Achalasia. This was over a year ago and I believe my symptoms are being managed with herbal chinese medicine and acupuncture. Before undergoing surgery, I would like to another manometry to see if my symptoms have further degenerated.