& GERD

October 9, 2001

In a message dated 10/9/2001 7:09:35 AM Central Daylight Time,

vzoelen@... writes:

<< On the other hand, we all

know that Achalasia patients suffer from heartburn. >>

Joop, I never had heartburn. Two different doctors told

me at the time of scoping that there was no acid in my

stomach. I was afraid after my dilatation that I might start

having heartburn but so far that has not happened. The

dilatation was done on September 19th.

Maybe I didn't have heartburn because I regretted most

of my food or as you say what did not manage to get into

the stomach. The only times I have ever had heartburn at

all was prior to developing Achalasia, or at least before I

ever had any of the symptoms. Only then when I ate very

spicy foods and too much of it at one time. After I began the regurgitation

I didn't have the heartburn at all.

Magg

October 9, 2001

Hallo Everyone,

In response to Flora Alyce and Havi about the relation between GERD

and achalasia, I think we should discriminate different situations.

GERD occurs much more frequently than achalasia, generally because the

lower esophageal sphincter is too relaxed or the peristaltic movement

of the esophagus does not work properly. On the other hand, we all

know that achalasia patients suffer from heartburn. The possibility

that this heartburn is not caused by stomach acid but by fermentation

of remaining food in the esophagus is often heard, but does not

explain why this heartburn can be prevented by Losec, which

specifically blocks gastric acid acid production and not fermentation

in the esophagus.

In my opinion the fermentation theory can only be valid under severe

achalasia conditions where uptake by the stomach is strongly limited

and the esophagus is constantly filled with food remnants and water.

Reflux of gastric acid under these conditions will not cause

heartburn, because the acid is buffered by the fluid in the esophagus.

Under most achalasia conditions, however, we have problems to get our

food into the stomach, but with some effort it finally works out and

in between our meals the esophagus is largely empty. A normal

esophagus is a flexible tube that can open and close when necessary.

An achalasia esophagus can at best be considered as a stiff funnel,

with a broad tube and a small, inflexible ending. Because the funnel

is smaller than the tube we have problems to get the food into our

stomach. The stiff funnel is not fully closed, however, because the

sphincter cannot relax. Through this opening gastric acid can reflux

into the esophagus. What we do with a dilatation is to mechanically

increase the diameter of the funnel, with the consequence that food

gets easier into the stomach, but the gastric acid also gets up easier

into the esophagus.

If someone knows of alternative interpretations, I would be interested

to hear them.

Joop

October 9, 2001

I have achalasia and also a large pocket in the esophagus near the cardia valve

for food to ferment in. I almost never have heartburn, but then I never let

food accumulate in the esophagus. I drop it into the stomach and then flush the

last bits in with water.

The cardia valve is not relaxed normally but constricted. It is relaxed to let

food into the stomach. I have never had any treatment for achalasia. I believe

the treatment opens the cardia valve and often prevents it from fully closing,

thus permitting heartburn.

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From: vzoelen@...[sMTP:vzoelen@...]

Sent: Tuesday, October 09, 2001 5:07 AM

achalasia

Subject: achalasia & GERD