Re: More on dilatation

[Guest guest]

Good article -- thanks!

It is also worth remembering that dilitation is performed in an outpatient

setting. It is a non-surgical intervention. For me, the process was very

comfortable. The sedation meds used were outstanding. I sought out an

experienced practitioner who handles many achalasia cases. He is conservative -

never dilating to more than 35mm (some doctors will go to 40mm). His

perforation rate stats are below the typical range of numbers quoted in the

studies.

My point in all this is that dilitation is an option for treatment and relief of

symptoms for those not willing to entertain myotomy or those desiring a more

conservative approach. Those inclined to tolerate symptoms, " tough it out " , or

" wait for a cure " (and I include myself in this group) might find it worthwhile

to consider this treatment sooner than later.

I delayed treatment (dilitation) for a few years after my initial diagnosis. No

one has told me that this is the cause, but over the years my esophagus has

become quite enlarged and near-sigmoid in shape.

Fortunately myotomy is still an option for me but this will require the added

step of 'pulling down and straightening' my esophagus (re-section).

--Rich (in Chicago)

>

> If anyone is interested in dilatation as a first treatment there is a

> very good study that came out last fall.

>

> Predictors for outcome of failure of balloon dilatation in patients with

> achalasia

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002841

>

> One of the reasons I like this study is that they do a good job of

> pointing out the range of results of other studies for both dilatation

> and myotomy and point out how comparing them can be like comparing

> apples and oranges, not just in dilation compared to myotomy but

> dilatation compared to dilatation. They then select studies to compare

> apples to apples from both dilatation and myotomy studies. They show

> that what they do produces results that are in line with studies on

> myotomy.

>

> Here is what they do. They use a graded dilatation (PD) of 30, 35 and

> 40mm balloons on three consecutive days. Earlier they did 40, 40, 40 and

> later changed to the other. Graded over three days is going to be more

> expensive than doing it in one day but they do report good success this

> way.

>

> Dilatation sometime gets a bad rap in this support group. That is

> understandable because a lot of members have had poor results with it.

> Which could be because many of them may not have had dilatation that was

> aggressive enough. Too often dilatation is done with balloons that are

> only half the size of true achalasia balloons, or a small achalasia

> balloon is used but bigger ones may have been needed to fallow up the

> smaller ones to get lasting results. So, oranges to apples, their bad

> results may not mean much for someone that is considering graded

> dilatation with real achalasia balloons.

>

> Still there is the question of how much does dilatation effect the

> results of myotomy later. What this study does try to answer is what

> were the things that predicted dilatation failure in their patients. The

> main one they found that matters before having dilatation done is age.

> For them, as age before 50 was decreased the risk of achalasia symptom

> recurrence was increased. There are graphs and tables of this kind of stuff.

>

> If you wish to avoid the myotomy this is worth reading.

>

> notan

>

[Guest guest]

Hi Notan,

Thanks for sending this article and all the information that you provide. I

will read it and go back and read the posts during the last few weeks on

dilatations.

I had a dilatation with Dr. Kahrilas (he is really good at performing

dilatations) in Chicago on 4/22/10 and am doing really well. But I've also been

under the treatment of a Traditional Chinese Medicine (TCM)doctor in Naperville

who teaches at the Midwest School of Oriental Medicine in Chicago. See below

about the herbs. And I hve been getting acupuncture every three weeks up to now.

I'm going to have it every four weeks from now till I have no symptoms at all

for four more months.

Lately, I've had very few symptoms. However, November 20 and 22 I had more

severe regurgitation after eating but none since then. Prior to November it was

mild symptoms once or twice a month. I've gained weight back and my energy is

really good.

I am not taking any prescriptions except for high blood pressure. However, I am

taking special Chinese herbs in the form of tea 3 times a day and in oil that I

rub on my chest (both are for spasms). I don't have any painful spasms (only a

few bad ones right after the dilation when I was not on herbs).

Just thought I'd report on my progress...which is really good news.

Thanks again to Notan and everyone for all the help that you give.

Eva in Chicagoland

[Guest guest]

THANKS! If you don't mind I'll share it with the facebook group too.

>

> If anyone is interested in dilatation as a first treatment there is a

> very good study that came out last fall.

>

> Predictors for outcome of failure of balloon dilatation in patients with

> achalasia

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002841

>

> One of the reasons I like this study is that they do a good job of

> pointing out the range of results of other studies for both dilatation

> and myotomy and point out how comparing them can be like comparing

> apples and oranges, not just in dilation compared to myotomy but

> dilatation compared to dilatation. They then select studies to compare

> apples to apples from both dilatation and myotomy studies. They show

> that what they do produces results that are in line with studies on

> myotomy.

>

> Here is what they do. They use a graded dilatation (PD) of 30, 35 and

> 40mm balloons on three consecutive days. Earlier they did 40, 40, 40 and

> later changed to the other. Graded over three days is going to be more

> expensive than doing it in one day but they do report good success this

> way.

>

> Dilatation sometime gets a bad rap in this support group. That is

> understandable because a lot of members have had poor results with it.

> Which could be because many of them may not have had dilatation that was

> aggressive enough. Too often dilatation is done with balloons that are

> only half the size of true achalasia balloons, or a small achalasia

> balloon is used but bigger ones may have been needed to fallow up the

> smaller ones to get lasting results. So, oranges to apples, their bad

> results may not mean much for someone that is considering graded

> dilatation with real achalasia balloons.

>

> Still there is the question of how much does dilatation effect the

> results of myotomy later. What this study does try to answer is what

> were the things that predicted dilatation failure in their patients. The

> main one they found that matters before having dilatation done is age.

> For them, as age before 50 was decreased the risk of achalasia symptom

> recurrence was increased. There are graphs and tables of this kind of stuff.

>

> If you wish to avoid the myotomy this is worth reading.

>

> notan

>

[Guest guest]

Rich,

I also have a very large and sigmoid esophagus. I just had a myotomy in

October by Dr. Luketich at UPMC. He did not do a resection. He straightened it

out manually by mobilizing it. The results of this are not durable but I can

tell you that my esophagus is definitely " different " from what it was. I swallow

so well now, its amazing.

So, I am proof that you can have positive results with just a myotomy and a

sigmoid mega esophagus. I pray everyday that this will last for decades. Dr.

Awais - his assistant said it very well may....

Diameter of my esophagus at largest point - 10.5cm

Diameter of my esophagus at the smallest point - 9cm (very sad the entire thing

is dialated, not just distal end)

Sigmoid turn of 90 degrees at distal end (not sure if this is still the case as

it was straightened out to some extent). Well see in a year when I go back to

UPMC for my follow up.

> >

> > If anyone is interested in dilatation as a first treatment there is a

> > very good study that came out last fall.

> >

> > Predictors for outcome of failure of balloon dilatation in patients with

> > achalasia

> > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002841

> >

> > One of the reasons I like this study is that they do a good job of

> > pointing out the range of results of other studies for both dilatation

> > and myotomy and point out how comparing them can be like comparing

> > apples and oranges, not just in dilation compared to myotomy but

> > dilatation compared to dilatation. They then select studies to compare

> > apples to apples from both dilatation and myotomy studies. They show

> > that what they do produces results that are in line with studies on

> > myotomy.

> >

> > Here is what they do. They use a graded dilatation (PD) of 30, 35 and

> > 40mm balloons on three consecutive days. Earlier they did 40, 40, 40 and

> > later changed to the other. Graded over three days is going to be more

> > expensive than doing it in one day but they do report good success this

> > way.

> >

> > Dilatation sometime gets a bad rap in this support group. That is

> > understandable because a lot of members have had poor results with it.

> > Which could be because many of them may not have had dilatation that was

> > aggressive enough. Too often dilatation is done with balloons that are

> > only half the size of true achalasia balloons, or a small achalasia

> > balloon is used but bigger ones may have been needed to fallow up the

> > smaller ones to get lasting results. So, oranges to apples, their bad

> > results may not mean much for someone that is considering graded

> > dilatation with real achalasia balloons.

> >

> > Still there is the question of how much does dilatation effect the

> > results of myotomy later. What this study does try to answer is what

> > were the things that predicted dilatation failure in their patients. The

> > main one they found that matters before having dilatation done is age.

> > For them, as age before 50 was decreased the risk of achalasia symptom

> > recurrence was increased. There are graphs and tables of this kind of stuff.

> >

> > If you wish to avoid the myotomy this is worth reading.

> >

> > notan

> >

>

[Guest guest]

I am very glad to hear that things worked out so well for you!!

For those of us in the same boat, here's an encouraging article (abstract):

http://resources.metapress.com/pdf-preview.axd?code=81p0103034850011 & size=larges\

t

The article summarizes a study which concludes that " a laparoscopic Heller

myotomy relieved dysphagia in most patients with achalasia, even when the

esophagus was dilated " . In the past, myotomy was considered ineffective and

esophagectomy was the standard treatment. According to the article, this is no

longer so.

--Rich

>

>

> Rich,

> I also have a very large and sigmoid esophagus. I just had a myotomy in

October by Dr. Luketich at UPMC. He did not do a resection. He straightened it

out manually by mobilizing it. The results of this are not durable but I can

tell you that my esophagus is definitely " different " from what it was. I swallow

so well now, its amazing.

>

> So, I am proof that you can have positive results with just a myotomy and a

sigmoid mega esophagus. I pray everyday that this will last for decades. Dr.

Awais - his assistant said it very well may....

>

> Diameter of my esophagus at largest point - 10.5cm

> Diameter of my esophagus at the smallest point - 9cm (very sad the entire

thing is dialated, not just distal end)

>

> Sigmoid turn of 90 degrees at distal end (not sure if this is still the case

as it was straightened out to some extent). Well see in a year when I go back

to UPMC for my follow up.

[Guest guest]

Thanks Rich,

As I was going through my journey to find the right surgeon this summer, I

must have read every single abstract and study on the internet related to mega

esophagus in humans.

The one that caught my eye was actually negative. It was about the 4 predictors

of a failed myotomy. The co-author was my surgeon Dr. Luketich. I am sure you

can google it.

The 4 predictors were (in no particular order)

duration of disease (I had it for 19 years including year before dx)

prior surgery or dilatation (I had a dilatation)

size of esophagus (diameter) and if its sigmoid (10.5cm) yikes!

resting LES pressure of < 30mmhg (mine was avg 20mmhg)

I had all of these predictors and my results were still great. I guess i felt

really comfortable with a surgeon that was completely aware of all the

possibilities and knew exaclty how to handle a complicated case like mine.

Hopefully my results will continue to be good for years to come.

My surgeon did mention how my body has adapted so amazingly well to the sheer

size of my esophagus. He was surprised that I do not micro aspirate and

attributed that to my over-active cricopharyngeal sphincter. i guess it has

helped me out through the years because always had left over stasis sitting in

there.

Sorry for the story, just thought you might have found it interesting.

c

> >

> >

> > Rich,

> > I also have a very large and sigmoid esophagus. I just had a myotomy in

October by Dr. Luketich at UPMC. He did not do a resection. He straightened it

out manually by mobilizing it. The results of this are not durable but I can

tell you that my esophagus is definitely " different " from what it was. I swallow

so well now, its amazing.

> >

> > So, I am proof that you can have positive results with just a myotomy and a

sigmoid mega esophagus. I pray everyday that this will last for decades. Dr.

Awais - his assistant said it very well may....

> >

> > Diameter of my esophagus at largest point - 10.5cm

> > Diameter of my esophagus at the smallest point - 9cm (very sad the entire

thing is dialated, not just distal end)

> >

> > Sigmoid turn of 90 degrees at distal end (not sure if this is still the case

as it was straightened out to some extent). Well see in a year when I go back

to UPMC for my follow up.

>

[Guest guest]

Thanks for relating the details of your story.

In my eyes, the main takeaway is not rushing to 'ectomy in this situation.

There are a couple schools of thought - and one is that myotomy works well

even with a dilated 'tortuous' esophagus. According to my surgeon,

sigmoid/grossly dilated esophagi(?) represent about 1% of achalasia cases. So,

I think it is important to find a surgeon with a substantial number of surgeries

under his/her belt.

I get mine done this Wednesday .

-Rich

> > >

> > >

> > > Rich,

> > > I also have a very large and sigmoid esophagus. I just had a myotomy in

October by Dr. Luketich at UPMC. He did not do a resection. He straightened it

out manually by mobilizing it. The results of this are not durable but I can

tell you that my esophagus is definitely " different " from what it was. I swallow

so well now, its amazing.

> > >

> > > So, I am proof that you can have positive results with just a myotomy and

a sigmoid mega esophagus. I pray everyday that this will last for decades. Dr.

Awais - his assistant said it very well may....

> > >

> > > Diameter of my esophagus at largest point - 10.5cm

> > > Diameter of my esophagus at the smallest point - 9cm (very sad the entire

thing is dialated, not just distal end)

> > >

> > > Sigmoid turn of 90 degrees at distal end (not sure if this is still the

case as it was straightened out to some extent). Well see in a year when I go

back to UPMC for my follow up.

> >

>

[Guest guest]

Rich, good luck I will keep you in my prayers. The really big item that I did

not tell you in my prior posts was that I could swallow. I never had dysphagia

after my dilatation in 1996. Yes, it was harder for me to swallow than the rest

of the non achalasia population. But compared to most acalasians , I was

managing very well. I drank lots of water to push it down, no spasms, no

heartburn. I did get the occasional stuckage that would cause massive amounts

of panic but those were uncommon. That is why I chose to ignore it for 14 years.

I could swallow! I had no idea I was stretching the entire length of my

esophagus.

But my surgeon did tell me this. My results were going to be good because I was

able to swallow so well. And now my swallowing is even better than I could ever

imagine.

I hope you get the same results!!

> > > >

> > > >

> > > > Rich,

> > > > I also have a very large and sigmoid esophagus. I just had a myotomy

in October by Dr. Luketich at UPMC. He did not do a resection. He straightened

it out manually by mobilizing it. The results of this are not durable but I can

tell you that my esophagus is definitely " different " from what it was. I swallow

so well now, its amazing.

> > > >

> > > > So, I am proof that you can have positive results with just a myotomy

and a sigmoid mega esophagus. I pray everyday that this will last for decades.

Dr. Awais - his assistant said it very well may....

> > > >

> > > > Diameter of my esophagus at largest point - 10.5cm

> > > > Diameter of my esophagus at the smallest point - 9cm (very sad the

entire thing is dialated, not just distal end)

> > > >

> > > > Sigmoid turn of 90 degrees at distal end (not sure if this is still the

case as it was straightened out to some extent). Well see in a year when I go

back to UPMC for my follow up.

> > >

> >

>

[Guest guest]

Eva wrote:

> ... I will read it and go back and read the posts during the last few weeks on

dilatations. ...

Another one you may want to look at is:

Achalasia - An Update

E Richter, MD, FACP, MACGcorresponding author

Department of Medicine, Temple University School of Medicine,

Philadelphia, USA

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

See the section on dilatation. The rest is good too.

I posted a link to it more than a few weeks ago.

> Just thought I'd report on my progress...which is really good news.

Good reports are always nice to hear, but we want to hear them all.

Thanks for the update.

notan

[Guest guest]

Lisbeth wrote:

> THANKS! If you don't mind I'll share it with the facebook group too.

It is meant to be shared.

notan

[Guest guest]

I'm interested in what other research you've seen on the association between

infectious diseases and onset of achalasia (if you recall coming across anything

in your wealth of information).  I've often thought that was part of my onset,

although once diagnosed, I was informed that my grandfather and also my aunt

(both on my mothers side) had/have a history of dysphasia as well.  While in

the hospital for my myotomy back in 1998, I was diagnosed with urticaria, which

I still have to this day, without break.  (Between scratching and regurgitating

and chest pain, I'm a joy to live with )  I always found it very odd that

the urticaria started exactly at the same time (I was only " sick " for 3 months

before my myotomy and had a very quick progression of my achalasia).

Very interesting article though, and I'm still reading

kim

> ... I will read it and go back and read the posts during the last few weeks on

dilatations. ...

Another one you may want to look at is:

Achalasia - An Update

E Richter, MD, FACP, MACGcorresponding author

Department of Medicine, Temple University School of Medicine,

Philadelphia, USA

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

See the section on dilatation. The rest is good too.

I posted a link to it more than a few weeks ago.

> Just thought I'd report on my progress...which is really good news.

Good reports are always nice to hear, but we want to hear them all.

Thanks for the update.

notan

[Guest guest]

Probably TMI, but anything for the cause.

First of all I have Herpes Simplex, have had it since I was a child.

Secondly although not infectious I have had a rare disorder called Mal de

Debarquement Syndrome since 1999. Current studies with fMRI are showing

hyperactivity in the motor cortex, Transcranial Magnetic Stimulation (TMS) is

going to be trialed for treatment. I have not been able to participate in the

trials as it requires travel either to UCLA or Ohio. My current medication

treatment for this disorder is epam and Lexapro.

I acquired dysphagia in Feb. 2008 shortly after the death of a dear friend in

Jan. 2008. I haven't been much of a drinker since onset of MdDS since 1999,

very rare occasion. However, when my friend died I downed a whole bottle of

wine, I remember sitting in a chair bent over with grief, I think this was the

beginning of things to come, certainly think it contributed to my developing a

hiatal hernia. Depression, grief, bent over in that chair, rocking from MdDS, in

a stupor from wine now add epam and Lexapro. Not a good scenario.

Would I have gotten Achalasia anyway? Heaven only knows! Minus the grief and

wine, I do feel my MdDS played a huge part.

When I met with my surgeon who performed my myotomy, when describing my MdDS

symptoms he even said that is was a motor disorder.

Before being diagnosed with Achalasia my diagnosis was spastic motor esophageal

spasm if I remember correctly or something along those lines, would have to dig

through paperwork. I feel Achalasia is a brain thing.

Donna Hall

>

> > ... I will read it and go back and read the posts during the last few weeks

on dilatations. ...

>

>

>

> Another one you may want to look at is:

>

>

>

> Achalasia - An Update

>

> E Richter, MD, FACP, MACGcorresponding author

>

> Department of Medicine, Temple University School of Medicine,

>

> Philadelphia, USA

>

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

>

>

>

> See the section on dilatation. The rest is good too.

>

>

>

> I posted a link to it more than a few weeks ago.

>

>

>

> > Just thought I'd report on my progress...which is really good news.

>

>

>

> Good reports are always nice to hear, but we want to hear them all.

>

>

>

> Thanks for the update.

>

>

>

> notan

>

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[Guest guest]

Hi Kim - interesting that you may have a family connection. My father was just

diagnosed with esophageal spasms (after having pressure and difficulty breathing

for about 30 min. and going to the hospital to rule out a heart attack) and

there is research being done in Germany to look at genetic connections. It is

believed now that there may be some gene that can cause variants of esophageal

motility issues. If you would be willing, the doctor in Germany doing the

research is Dr. Inez Gockel and she is currently coordinating getting saliva

samples from families with potential genetic variants through some University

Medical Centers in the US. She can be reached at gockel@...

Anyone else with a family history of dysphasia or achalasia or the like may try

her as well. Last I contacted her, she had about 1000 people in Europe

contributing to her research and she was coordinating with Dr.'s Luketich in

Pittsburgh, Pellegrini in Seattle and s from Rochester to collect samples

from people in the states.

I'm sure what she's doing will take years and of course, no guarantee of any

kind of 'cure' but I'm just so excited that someone in the medical community is

doing something.

~ in NC

>

> > ... I will read it and go back and read the posts during the last few weeks

on dilatations. ...

>

>

>

> Another one you may want to look at is:

>

>

>

> Achalasia - An Update

>

> E Richter, MD, FACP, MACGcorresponding author

>

> Department of Medicine, Temple University School of Medicine,

>

> Philadelphia, USA

>

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

>

>

>

> See the section on dilatation. The rest is good too.

>

>

>

> I posted a link to it more than a few weeks ago.

>

>

>

> > Just thought I'd report on my progress...which is really good news.

>

>

>

> Good reports are always nice to hear, but we want to hear them all.

>

>

>

> Thanks for the update.

>

>

>

> notan

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[Guest guest]

It is interesting that you say that " achalasia is more of a brain thing. " My

Traditional Chinese Medicine (TCM) doc keeps telling me that the brain has to

have less " heat " (special definition in TCM)and more moisture. (Also more

moisture in the esophagus and less heat, ie. from a practical point...no heating

pads on the chest.) But my TCM doc has stressed the importance of the brain in

achalasia ... I really don't understand it all.

Eva in Chicagoland

> >

> > > ... I will read it and go back and read the posts during the last few

weeks on dilatations. ...

> >

> >

> >

> > Another one you may want to look at is:

> >

> >

> >

> > Achalasia - An Update

> >

> > E Richter, MD, FACP, MACGcorresponding author

> >

> > Department of Medicine, Temple University School of Medicine,

> >

> > Philadelphia, USA

> >

> > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

> >

> >

> >

> > See the section on dilatation. The rest is good too.

> >

> >

> >

> > I posted a link to it more than a few weeks ago.

> >

> >

> >

> > > Just thought I'd report on my progress...which is really good news.

> >

> >

> >

> > Good reports are always nice to hear, but we want to hear them all.

> >

> >

> >

> > Thanks for the update.

> >

> >

> >

> > notan

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

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> >

[Guest guest]

Thanks, Notan. I will read it.

Also, have you run across any connection between too much mercury and

Achalasia?

Eva

> > ... I will read it and go back and read the posts during the last few weeks

on dilatations. ...

>

> Another one you may want to look at is:

>

> Achalasia - An Update

> E Richter, MD, FACP, MACGcorresponding author

> Department of Medicine, Temple University School of Medicine,

> Philadelphia, USA

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

>

> See the section on dilatation. The rest is good too.

>

> I posted a link to it more than a few weeks ago.

>

>

> > Just thought I'd report on my progress...which is really good news.

>

> Good reports are always nice to hear, but we want to hear them all.

>

> Thanks for the update.

>

> notan

>

[Guest guest]

Great Article!

LES pressure can be transiently reduced by smooth muscle

relaxants.

http://www.ncbi.nlm.nih.gov/sites/ppmc/articles/PMC2912115/

The same holds true for sildenafil (VIAGRA), a phosphodiesterase

inhibitor that reduces the breakdown of cyclic guanosine

monophosphate, the second messenger mediating NO induced

relaxation.

Has anybody tried this Viagra or FDA Approves Daily Cialis Dosage.

Daily dose may let men be more spontaneous.

Cialis 5mg daily may work. What about women?

Ray CA OC

> > ... I will read it and go back and read the posts during the last few weeks

on dilatations. ...

>

> Another one you may want to look at is:

>

> Achalasia - An Update

> E Richter, MD, FACP, MACGcorresponding author

> Department of Medicine, Temple University School of Medicine,

> Philadelphia, USA

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912115

>

> See the section on dilatation. The rest is good too.

>

> I posted a link to it more than a few weeks ago.

>

>

> > Just thought I'd report on my progress...which is really good news.

>

> Good reports are always nice to hear, but we want to hear them all.

>

> Thanks for the update.

>

> notan

>

[Guest guest]

Kim wrote:

> I'm interested in what other research you've seen on the association between

infectious diseases and onset of achalasia ...

Research into infection and achalasia has not found any clear answers.

Herpes is a good example. There is evidence that herpes is not doing the

damage yet there is also evidence that herpes may have had something to

do with making the damage possible. Many people with achalasia have said

the time their achalasia started was a time of stress and that stress

continues to makes it worse. One of the things stress does is change the

workings of the immune system. It may be that infection in general is

like stress for achalasia and that it takes these kind of times to start

the destructive process or flare it up. Times of stress are times one

is also more likely to get other infections.

Below are some links, with short quotes, related to this topic.

notan

1. Birgisson S, Galinski MS, Goldblum JR, Rice TW, Richter JE.

Achalasia is not associated with measles or known herpes and human

papilloma viruses.

Dig. Dis. Sci. 1997;42(2):300-306.

http://www.ncbi.nlm.nih.gov/pubmed/8617125

" The absence of HV, MV, and HPV sequences suggests that these viruses

are not associated with achalasia but does not exclude the possibility

of a previously unidentified virus as a causal agent. "

2. Dantas RO, Meneghelli UG.

Achalasia occurring years after acute poliomyelitis.

Arq Gastroenterol. 1993;30(2-3):58-61.

http://www.ncbi.nlm.nih.gov/pubmed/8147735

" It is possible that lower esophageal sphincter achalasia was the

consequence of lesion in the dorsal motor nucleus of the vagus nerve

caused by poliomyelitis. The association between poliomyelitis and

achalasia supports the infective hypothesis as the cause of achalasia. "

3. Benini L, Sembenini C, Bulighin GM, et al. Achalasia.

A possible late cause of postpolio dysphagia.

Dig. Dis. Sci. 1996;41(3):516-518.

http://www.ncbi.nlm.nih.gov/pubmed/8617125

" In patients with postpolio dysphagia, the possible presence of

achalasia must be considered. "

4. Boeckxstaens GE.

Achalasia: virus-induced euthanasia of neurons?

Am. J. Gastroenterol. 2008;103(7):1610-1612.

http://www.ncbi.nlm.nih.gov/pubmed/18557706

" These exciting data suggest that achalasia is an immune-mediated

inflammatory disease in which a (latent) infection with HSV-1 leads to

persistent immune activation and self-destruction of esophageal neurons,

most likely in genetic susceptible subjects only. "

5. Niwamoto H, Okamoto E, Fujimoto J, et al.

Are human herpes viruses or measles virus associated with esophageal

achalasia?

Dig. Dis. Sci. 1995;40(4):859-864.

http://www.ncbi.nlm.nih.gov/pubmed/7720482

" Therefore, a specific viral etiology for achalasia was not identified

in this study. "

6. Lau KW, McCaughey C, Coyle PV, Murray LJ, ston BT.

Enhanced reactivity of peripheral blood immune cells to HSV-1 in primary

achalasia.

Scand. J. Gastroenterol. 2010;45(7-8):806-813.

http://www.ncbi.nlm.nih.gov/pubmed/20438398

" These results indicate that the PBMCs of patients with primary

achalasia show an enhanced immune response to HSV-1 antigens. The data

suggest that there is persistent stimulation of immune cells by herpes

simplex virus type 1 (HSV-1) or HSV-1 like antigen moieties. "

7. Castagliuolo I, Brun P, Costantini M, et al.

Esophageal achalasia: is the herpes simplex virus really innocent?

J. Gastrointest. Surg. 2004;8(1):24-30; discussion 30.

http://www.ncbi.nlm.nih.gov/pubmed/14746832

" The results of this study indicate that HSV-1-reactive immune cells are

present in lower esophageal sphincter muscles of patients with achalasia. "

8. Facco M, Brun P, Baesso I, et al.

T cells in the myenteric plexus of achalasia patients show a skewed TCR

repertoire and react to HSV-1 antigens.

Am. J. Gastroenterol. 2008;103(7):1598-1609.

http://www.ncbi.nlm.nih.gov/pubmed/18557707

" These data suggest that the oligoclonal lymphocytic infiltrate within

the LES of achalasia patients may represent the trace of an

immune-inflammatory reaction triggered by HSV-1 antigens and that the

Th1-type cytokines released by the activated lymphocytes may contribute

to establish the neuronal damage accounting for the clinical features of

idiopathic achalasia. "

[Guest guest]

Donna wrote:

> ... I feel Achalasia is a brain thing. ...

It can be, but in most cases when tissue from the LES of patients is

studied there is neural damage there, missing neurons. These are the

neurons that control the relaxing of the LES. If they don't do their job

the LES stays shut.

notan

[Guest guest]

Eva_wrote:

> ... have you run across any connection between too much mercury and

> Achalasia? ...

No.

One of the interesting things is that the incidence of achalasia seems

to be about the same in various locations around the world. You would

think that different cultures and environments would expose people to

different levels of such things as mercury, and change the incidence if

achalasia was effected by such a thing.

notan

[Guest guest]

Ray wrote:

> Has anybody tried this Viagra or FDA Approves Daily Cialis Dosage.

> Daily dose may let men be more spontaneous.

Studies have found that sildenafil (Viagra) does reduce LES pressure but

even so they have not shown that it helps. Patients with achalasia did

not show improved symptoms even if they did show lower LES pressure. The

studies are small so maybe they just didn't have enough patients to test

and find some that it would have helped.

notan

Effects of sildenafil on esophageal motility of patients with idiopathic

achalasia.

http://www.ncbi.nlm.nih.gov/pubmed/10648452

" Lower esophageal sphincter tone, residual pressure, and wave amplitude

after sildenafil showed a significant decrease compared with both the

basal period and the placebo group, with a marked interpatient

variability. The inhibitory effect reached its maximum (about -50%)

15-20 minutes after the infusion and lasted <1 hour. "

Effect of sildenafil on oesophageal motor function in healthy subjects

and patients with oesophageal motor disorders

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1773249

" None of the patients with achalasia showed improvement in oesophageal

symptoms. "