Q: I need help! I’ve had a lot of trouble swallowing. I choke on food. A gastroenterologist did an endoscopy and said I had achalasia. He did a BOTOX treatment that didn’t work. I am 84 but still need to eat. I eat mashed foods, applesauce and lots of juices but after a few swallows, stuff still feels like it’s stuck in the back of my throat.
My doctor won’t suggest surgery and he said stretching is out because of a possible perforation. Meds aren’t an option because of allergies. He said all of the possible procedures would need repeating every two months or so. I saw some expensive meds on the internet ($400.00 for two months) but they were from Norway and Australia. Then I read they were a scam. They didn’t work and in spite of a guarantee, there was no way to get the money back.
I understand any pills I take probably stay in the esophagus for a day or so until they eventually drain through, so what can I do? I am miserable. Please make some suggestions. My doctor says not much can be done but he doesn’t explain much.
A: Yes, you certainly need help. Achalasia is a swallowing disorder that is rather rare, affecting about one in every 100,000 individuals. Most people are diagnosed between the ages of 25 and 60 and while there is no cure, symptoms can be vastly reduced with treatment. The condition is the result of nerve cells in the esophagus that fail to function properly, resulting in difficulties swallowing. Foods that are swallowed cannot be propelled through the esophagus on their way to the stomach, which is why you experience the symptoms you do. Other than feeling that liquids and solids are getting stuck, a patient may have chest pain, heartburn, experience a sensation of fullness, have hiccups, and experience weight loss.
Diagnosis may be made through one of several tests. The first is a barium swallow which involves swallowing a chalk-like liquid while simultaneous X-rays are taken. The liquid will reveal a narrowing at the end of the esophagus and dilation above that narrowed region. Another test is an esophageal motility study that measure pressure changes within the esophagus caused by muscle contractions. The testing may also reveal spastic contractions of the esophagus above the lower esophageal sphincter for a condition known as vigorous achalasia. High pressure in the lower esophageal sphincter at rest, and more important, failure of the sphincter to relax following swallowing plus the absence of peristaltic contractions in the lower esophagus, will confirm the diagnosis. Endoscopy utilizes a thin, lighted tube which allows a physician to view the inside of the esophagus and may also be used for confirmation of the suspected diagnosis.
While no treatment will restore normal esophageal contractions, drug therapy in the form of nitrates and calcium channel blockers may allow for sphincter relaxation. The drugs are placed under the tongue 10 to 30 minutes prior to each meal. Unfortunately, headaches and hypotension (low blood pressure) may present and the drugs have a tendency to become less effective over time. Therefore, this form of treatment is recommended for patients who either are not interested in or are not healthy enough to undergo balloon dilation or surgery. While BOTOX didn’t work for you, it generally relieves symptoms up to 90% of the time, yet unfortunately, injections will likely have to be repeated.
Still another option for selected patients is a minimally invasive technique known as laparoscopic esophagomyotomy or the Heller Myotomy. I recommend you have a frank talk with your physician to discuss this and other options. Doing nothing isn’t working and left untreated, achalasia can be debilitating, so perhaps a short-term trial with medication may be the answer. If you fail to experience improvement, I recommend you go to a large center where a good number of pneumatic dilations are performed.