Emotional problems and

[Guest guest]

According to A brasilian STUDY to light ETIOLOGY AND PROFILE OF THE achalasian

PATIENTS very interesting results seen.

Review of medical records from 78 patients operated at the Hospital de Clinicas

da Unicamp obstruction between 1989 and 2005 and the subsequent interview, using

directed questionnaire, reaching for common data between them and emphasizing

history, possible co-morbidities and associated factors. In the group of 78

records collected it was possible to contact and interview 33 patients.

Results - The main findings of this study were: 1) presence of a triggering

relevant emotional factor before the symptoms (80%) and over 30% with

psychiatric and/or psychological treatment reported; 2) typical childhood

infections highly prevalent (88% measles, varicella, rubella); 3) possible

associations with: exposure to chemicals, especially herbicides; other diseases

of the gastrointestinal tract, autoimmune diseases, genetic propensity and other

changes in the nervous system highlighting the seizures. Conclusions: The

idiopathic esophageal achalasia is probably an autoimmune disease, which seems

to be highly related to emotional problems.

i want quote some interesting results from that study...

-Among the few cases observed stand out monozygotic twins with alchalasia and

suggestion of transmission from father to son.

-In some of the cases observed, achalasia was present in children descendant

from consanguineous relations15. In a more recent research, Zilberstein, et

al.25, found nonchagasic twins developing typical symptoms of achalasia25. These

same authors considered idiopathic achalasia has expressions and symptoms

similar to Chagas Disease.

-The lower sphincter is, usually, more hypertonic in idiopathic esophageal

achalasia than it is in chagasic one. On the other hand, the dilatation of the

esophagus is more intense in the chagasic achalasia.

-the incidence of cancer was quite low in all cases of both diseases, there was

a higher occurrence in chagasic patients due to the duration of the dysphagia, a

risk factor.

-In relationship to their occupations, seven were agriculturists (21%); six

religious (18%); four (12%) in construction or domestic services; three (9%) in

carpentry or cleaning services; gardening two patients (6%). Three of the

patients (9%) had never executed any profession. The remaining had different

occupations

-In relationship to strong chemicals (possibly harmful), 19 patients (58%)

reported the contact. The most frequent were herbicides reported by 9 patients

(27%) in which 4 (12%) declared use of liquids derived from glyphosate; 3 (9%)

had intense contact with thinner and 2 (6%) reported contact with powdered lime

(one accidental ingestion). Other chemicals reported were kerosene, paint

remover, PVC glue, resins, stain remover, sulfates, diesel, bleach and strong

acids.

-Immunity related illnesses in this series were present in 10 patients (30%).

Two (6%) had bronchitis; one scleroderma and osteoarthritis, 5 (15%) allergic

exuberant episodes with insect bites, particular drugs or food allergy. One of

these patients was hospitalized for this reason and three quoted suggestive

symptoms of colagenosis by describing its inflammatory characteristics.

-Family history of achalasia or similar symptoms was obtained in 6 (18%) with

esophagus diseases besides gastroesophageal reflux.

-Consanguineous marriages were found in 6 (18%) patients. In five (15%),

inbreeding could not affect them because it was among cousins or uncles in the

first degree. Another patient reported his parents as cousins in the third

degre.

-In relationship to nervous system disorders, five patients (15%) reported a

history of seizures, four in childhood and one in adulthood.

-Thirteen patients (39%) reported smoking and 14 (42%) alcohol problems in a

minimum of five years.

-Emotional factors related were: 26 patients (79%) reported no important

emotional factor related to the beginning of symptoms, most of which were

derived from family problems (48%). Eleven (33%) said that they had done

psychological treatment and/or psychiatric treatment, confirming the importance

of these problems at the time.

-Use of drugs was reported by 13 (39%), continuous medication or other drugs

before the symptoms started. Eight of these (24%) used psychiatric medications,

the most prevalent was diazepam (12%) and phenobarbital (6%). There were also

reports of antihypertensive drugs, fluoxetine, antibiotics, replacement of T4,

haldol, illicit drug unspecified, drugs for ovarian cyst treatment and

scleroderma.

Typical childhood viral infections (varicella 70%, mumps 58%, measles 52%) were

present in 29 patients (88%). Interesting, one patient had rubella immediately

before dysphagia started.

Due to in the absence of patient etiology and profile based studies results of

this clinical experience made in brasil is very important. And lights emotional

problems or environmental factors(toxic agents) may trigger achalasia by

disturbing immune system.

full text link...

www.scielo.br/pdf/abcd/v23n1/04.pdf

Banu

[Guest guest]

Banu wrote:

> According to A brasilian STUDY to light ETIOLOGY AND PROFILE OF THE achalasian

PATIENTS very interesting results seen.

>

If anyone is interested it is also in HTML at:

Idiopathic esophageal achalasia: a study of etiology and profile of the

patients

Acalásia idiopática do esôfago: análise da história clínica e

antecedentes na etiologia e perfil dos pacientes

http://www.scielo.br/scielo.php?script=sci_arttext & pid=S0102-67202010000100004 & l\

ng=en & nrm=iso & tlng=en

> Review of medical records from 78 patients operated at the Hospital de

Clinicas da Unicamp obstruction between 1989 and 2005 and the subsequent

interview, using directed questionnaire, reaching for common data between them

and emphasizing history, possible co-morbidities and associated factors. In the

group of 78 records collected it was possible to contact and interview 33

patients.

Notice that they only had 33 patients that were interviewed and some of

the results are based only on the interviews. We have more than that

here in this group.

> 1) presence of a triggering relevant emotional factor before the symptoms

(80%) and over 30% with psychiatric and/or psychological treatment reported;

Stress has been noticed many times in studies as being reported in the

context of developing or worsening of symptoms by achalasia patients but

also by patients of many disorders. It is not clear though that stress

is acting in any special causal way different from the effect it has in

other disorders. My guess, for what its worth, would be that stress does

not cause these disorders but it weakens the system so other causal

factors can take advantage and become destructive. Kind of like being

kill by playing in the street. Playing in the street doesn't kill you

but the car that hits you does. If you want to be healthy, live a

happy, peaceful, but active, life.

> 2) typical childhood infections highly prevalent (88% measles, varicella,

rubella);

Typical childhood infections are generally prevalent or they wouldn't be

typical. What are the rates for non-achalasia subjects in Brazil? Being

sick is also stress.

> 3) possible associations with: exposure to chemicals, especially herbicides;

other diseases of the gastrointestinal tract, autoimmune diseases, genetic

propensity and other changes in the nervous system highlighting the seizures.

I have problems with this section. Exposure to chemicals is very common.

Is there anyone in our group that isn't exposed to chemicals? But what

does " chemicals " mean? It is by their own words, " strong chemicals

(possibly harmful) " or put another way, " powerful and dangerous

chemicals. " They include bleach in that group. Who has not had some

contact with bleach? I am sure that ethanol is as powerful and harmful

as some of the " chemicals " listed. If we count that then it becomes even

more likely that people have been exposed to " chemicals. "

For immunity related illnesses they include a patient who was treated

for scleroderma. Scleroderma causes secondary achalasia. That patient

should have been excluded from the study. They also include " allergic

exuberant episodes " to things like insect bites, drugs and food. The

problem with these is that there are many things a person could react

to. They had 5 subjects that had these episodes. In a group of 33 people

what do you think the probability is of there being someone with an

allergy to an insect, drug, or food, or to any of a number other things

that could have counted in this category? Is 5 an unlikely number? How

unlikely? I suspect that in parts of Brazil there would be many kinds of

insects and insect bites would be common.

Many studies follow these kind of methods. Other studies turn the

hypotheses around. In stead of asking if people with a disease use a any

of a group of chemical they see if people who use a certain chemical

have the disease. Likewise allergic episodes, if you have them how

likely are you to have the disease? So, instead of fishing for many

things that subjects with a disease may have been exposed to the studies

focuses on subjects that are exposed to a specific thing, or type of

thing, that may cause the disease. So, instead of focusing on achalasia

subjects, you could focus on insect bite subjects and see how many of

them get achalasia. When these kind of studies are done relationships

like those seen in this study may disappear. The problem in achalasia is

that you could need thousands of subjects to get meaningful results, at

least meaningful negative results.

> Conclusions: The idiopathic esophageal achalasia is probably an autoimmune

disease, which seems to be highly related to emotional problems.

>

I am not in favor of the phrase " emotional problems, " too loaded, so I

would just call it stress or emotion stress. I don't doubt that stress

and immunity issues, auto and otherwise, have some place in the

development of achalasia. At least for some people. This study has to be

taken as one of many and there are others that cast doubt on the

importance of these conclusions. We have been told in the support group

that doctor Rice is telling people that it is probably autoimmune, but

there are other experts that don't think so. I have been told by one

researcher that it is probably caused by an allergic reaction but not an

autoimmune reaction, something like eosinophilic esophagitis but not

exactly. I am sure there are still others saying it is a virus problem.

I still favor the perfect storm of causes coming together to start a

cascade that lasts after the storm is over.

> i want quote some interesting results from that study...

>

> -Among the few cases observed stand out monozygotic twins with alchalasia and

suggestion of transmission from father to son.

>

These are not results in this study but are a part of a discussion about

findings reported in other papers. In this study " consanguineous

marriages were found in 6 (18%) patients " . I don't know what the rate of

consanguineous marriages is in Brazil. From what I have read the

incidence of primary achalasia is about the same in most studies from

around the world. If consanguineous marriages are a factor then the

incidence rate should be higher in cultures where that is more common.

There is an even rarer form of achalasia that is genetic and is found in

a community of limited genetic variation. It is possible that some of

the case reports of families with more than one achalasia case are

either very unlucky or have some very rare genetic form that is not the

common idiopathic form. Also, if there is a genetic risk for achalasia

which is different from a cause. Family members exposed to the same

cause and having a shared genetic risk could have more than one develop

achalasia, but if the risk is very small most families would have none

and very few would have two or more. This seems likely, not a genetic

cause but a genetically influenced risk for achalasia.

> -In relationship to their occupations, seven were agriculturists (21%); six

religious (18%); four (12%) in construction or domestic services; three (9%) in

carpentry or cleaning services; gardening two patients (6%). Three of the

patients (9%) had never executed any profession. The remaining had different

occupations

>

More fishing and confounding variables. Do these occupations have a

relationship because of chemicals or because of stress or something not

even thought of, or is this all just chance? I agree with the authors,

" The occupation does not seem to establish strong correlation, since

they were very diverse. " You would think that if certain strong

chemicals were a factor then occupation would have been a more important

factor too.

> -In relationship to nervous system disorders, five patients (15%) reported a

history of seizures, four in childhood and one in adulthood.

>

This seems high to me. Fever can cause childhood seizures. There may be

more fever in parts of Brazil. But if there is a connection of that sort

then countries with more childhood fever should have higher incidences

of achalasia. It would be interesting to have this statistic from other

countries.

> 14 (42%) alcohol problems in a minimum of five years.

>

Dangerous chemical. ;-) Careful I don't want to start a fight about

drinking.

> Eleven (33%) said that they had done psychological treatment and/or

psychiatric treatment, confirming the importance of these problems at the time.

>

What is the normal rate in Brazil?

It is an interesting but questionable study.

notan