Achalasia Update: Meeting with surgeon

After two years battling dysphagia, regurgitation, and spitting up foamy messes, I’ve  finally gone and met a surgeon.  I was reccomennded to Dr. Carmine Simone by my  GI specialist, Dr. Sam Friedlander.  It took about 3 weeks to get an appointment with Dr. Simone.

Dr. Simone went over the procedure, and basically told me what I already knew.  From my tests I had zero peristalsis and a LES pressure slightly above the mean. He recommend that I get a laparoscopic Heller myotomy, but without a fundoplication due to my complete lack of peristalsis.

I’ve booked the surgery for January, as to not interfere too much with the school term.  Apparently the doctors do not perform surgery during exam/christmas time, which basically makes them unavailable for most of December.

I also asked Dr. Simone what he though about POEM as a surgical technique.  He said that there were POEM trials held by Dr. Marylin at another hospital in Toronto, and that he would not recommend it.  He also said that his opinion was biased, gave me Dr. Marylin’s contact information, and suggested I should contact him myself.

I will be continuing reciving treatment from Dr. Chen at AC99 until the surgery.  I’ve had noticeable improvements since I’ve started acupuncture.  Next week I will be starting a combination of acupuncture and herbal extracts.  Dr. Chen seems to think he can restore peristalsis, so I will continue with his treatments.

I also requested a second manometry test to see if the acupuncture has had any unbiased measurable effect.  However I believe I was put on the low priority waiting list for this test because I had it done once before.

Everything to know about Esophageal Achalasia: Western Diagnostic Techniques

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.

Personal experience

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.