A progression and also Alcohol-Stasis

[Guest guest]

It is often recommended by people in this group to make sure the

esophagus is empty before going to bed for a number of reasons, choking,

aspiration and esophageal dilation being three of them. I have suggested

that it may not be good to let foods that irritates the esophagus to sit

in it at any time but especially at night as this may trigger spasms or

cause inflammation, infection, ulcers and perhaps add to the risk of

cancer. Here is an interesting case of an alcoholic with achalasia that

also had acute necrotizing esophagitis or “black esophagus.”

Achalasia, Alcohol-Stasis, and Acute Necrotizing Esophagitis: Connecting

the Dots

K. Lee, Valmik Bhargava, Ravinder K. Mittal, and Pradipta Ghosh

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029818/

" Given that patients with achalasia rely heavily on gravity to clear the

aperistaltic esophagus of its contents, and our patient reported

regularly passing out after excessive drinking, i.e., eliminated

gravitational clearing of the esophagus by assuming supine posture, the

risk of stasis-esophagitis was likely heightened. "

Most of us probably don't have much risk of getting black esophagus but

a number of people here have had esophagitis and esophageal ulcers.

Sometimes that is due to acid reflux but stasis, (not just alcohol

stasis) can also cause it and as seen above it is called

stasis-esophagitis in that case. The point is, keep the esophagus clear

as much as possible, especially when sleeping, and especially clear of

things that can irritate it. Among those thing are medications, acidic

foods, and herbs and foods you may be sensitive to or allergic too. I

put herbs in there with food instead of just saying foods because

sometimes we use herbs not as food. A lot of people have food allergies

and don't have a clue that they do. For the most part these may not

bother them much, or even enough to notice, but if they got a food

allergy test they might find that there are a number foods they test

positive to for allergies. Same thing for herbs. Plant allergies are

common and there is no reason a person couldn't be allergic to an herb.

Again it may be mild enough that most people would not notice. When food

sits in the esophagus, even those things that we would normally not

notice, and would normally not cause a problem, have enough time for our

immune systems to react to or for the chemicals in them to do damage.

Consider the following abstract:

Electron microscopic studies of esophageal wall structures in patients

with achalasia: casting more light on unresolved aspects of pathogenesis.

Bohl JR, Junginger T, Eckardt VF, Lang H, Müller M, Gockel I.

Department of General and Abdominal Surgery, Johannes

Gutenberg-University of Mainz, Germany.

http://www.ncbi.nlm.nih.gov/pubmed/20698218

" Our electron microscopic studies suggest that mast cells may play an

important role in the secondary pathogenesis of achalasia. Esophageal

retention and bacterial overgrowth with stasis esophagitis causing

mucosal injury may be a mechanism of increased antigen exposure. "

Mast cells release histamine and other chemicals in response to allergic

reactions, injury or inflammation. In an allergic reaction it is the

antigens of the allergen that the immune system reacts to. So, things

that we are allergic to, including the bacteria that forms on food in

stasis, and things that damage or cause inflammation, such as alcohol or

acids, can cause the mast cells to release histamine. It is histamine

that makes your eyes burn and your sinuses become inflamed when you have

a cold or allergy. Your esophagus will react to histamine in a similar

way. It is possible that this reaction of mast cells to irritation and

allergens results in the progression of damage to the system that

controls the muscles in achalasia.

Now consider this abstract:

Interstitial cells of Cajal, macrophages and mast cells in the gut

musculature: morphology, distribution, spatial and possible functional

interactions.

Mikkelsen HB.

Department of Cellular and Molecular Medicine, Faculty of Health

Sciences, University of Copenhagen, Copenhagen N, Denmark. hannem@...

" Interstitial cells of Cajal (ICC) are recognized as pacemaker cells for

gastrointestinal movement and are suggested to be mediators of

neuromuscular transmission. ... In more chronic conditions such as

Crohn's disease and achalasia, ICC and mast cells develop close spatial

contacts and piecemeal degranulation is possibly triggered. "

Interstitial cells of Cajal are reduced in number in achalasia. The

damage in achalasia that causes loss of control for relaxing the LES is

not just to the nerves but also to the ICC which interface with the

nerves and muscles. In achalasia the close contact of mast cells and ICC

puts the ICC at risk when the mast cells are triggered.

So, be kind to your ICC. Don't trigger your esophageal mast cells by

leaving them expose to irritants and allergens. By being kind to them

you may slow the progression of achalasia, but there are no guarantees

and more research is needed.

notan

[Guest guest]

Hi notan

Two great articles, that is why I say to wait before having a myotomy.

I am SURE notan will find a solution for the young ones who get Achalasia. May

not happen for me because of my age.

Achalasia can be handled, just study this site, many like me put up with it.

MANY have said what you can eat and survive.Yes it is difficult at times, only

when I eat something bad. I am retired so also I study the internet looking for

a solution, I am sure it would be hard for some one working or going to school.

As notan says KEEP the e empty at night, if you do the next day will be much

better, let gravity do its work and stay active after each meal. I do this every

day even at 80 working in the garden or painting.

How do I keep the e clear at night. I sit up and drink a full 16 oz glass of

water over a few minutes, I try to swallow normally with a BIG GULP. With in a

few minutes the crap comes up. I use a spit up glass so I don't have to go to

the sink. Also some nights I also have an Ensure plus, this also helps bringing

up the crap. Then NO spit ups in the bed, I originally had this problem in my

early days before my diagnosis.

Ray CA OC 80

>

> It is often recommended by people in this group to make sure the

> esophagus is empty before going to bed for a number of reasons, choking,

> aspiration and esophageal dilation being three of them. I have suggested

> that it may not be good to let foods that irritates the esophagus to sit

> in it at any time but especially at night as this may trigger spasms or

> cause inflammation, infection, ulcers and perhaps add to the risk of

> cancer. Here is an interesting case of an alcoholic with achalasia that

> also had acute necrotizing esophagitis or " black esophagus. "

>

> Achalasia, Alcohol-Stasis, and Acute Necrotizing Esophagitis: Connecting

> the Dots

> K. Lee, Valmik Bhargava, Ravinder K. Mittal, and Pradipta Ghosh

> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029818/

> " Given that patients with achalasia rely heavily on gravity to clear the

> aperistaltic esophagus of its contents, and our patient reported

> regularly passing out after excessive drinking, i.e., eliminated

> gravitational clearing of the esophagus by assuming supine posture, the

> risk of stasis-esophagitis was likely heightened. "

>

> Most of us probably don't have much risk of getting black esophagus but

> a number of people here have had esophagitis and esophageal ulcers.

> Sometimes that is due to acid reflux but stasis, (not just alcohol

> stasis) can also cause it and as seen above it is called

> stasis-esophagitis in that case. The point is, keep the esophagus clear

> as much as possible, especially when sleeping, and especially clear of

> things that can irritate it. Among those thing are medications, acidic

> foods, and herbs and foods you may be sensitive to or allergic too. I

> put herbs in there with food instead of just saying foods because

> sometimes we use herbs not as food. A lot of people have food allergies

> and don't have a clue that they do. For the most part these may not

> bother them much, or even enough to notice, but if they got a food

> allergy test they might find that there are a number foods they test

> positive to for allergies. Same thing for herbs. Plant allergies are

> common and there is no reason a person couldn't be allergic to an herb.

> Again it may be mild enough that most people would not notice. When food

> sits in the esophagus, even those things that we would normally not

> notice, and would normally not cause a problem, have enough time for our

> immune systems to react to or for the chemicals in them to do damage.

>

> Consider the following abstract:

>

> Electron microscopic studies of esophageal wall structures in patients

> with achalasia: casting more light on unresolved aspects of pathogenesis.

> Bohl JR, Junginger T, Eckardt VF, Lang H, Müller M, Gockel I.

> Department of General and Abdominal Surgery, Johannes

> Gutenberg-University of Mainz, Germany.

> http://www.ncbi.nlm.nih.gov/pubmed/20698218

> " Our electron microscopic studies suggest that mast cells may play an

> important role in the secondary pathogenesis of achalasia. Esophageal

> retention and bacterial overgrowth with stasis esophagitis causing

> mucosal injury may be a mechanism of increased antigen exposure. "

>

> Mast cells release histamine and other chemicals in response to allergic

> reactions, injury or inflammation. In an allergic reaction it is the

> antigens of the allergen that the immune system reacts to. So, things

> that we are allergic to, including the bacteria that forms on food in

> stasis, and things that damage or cause inflammation, such as alcohol or

> acids, can cause the mast cells to release histamine. It is histamine

> that makes your eyes burn and your sinuses become inflamed when you have

> a cold or allergy. Your esophagus will react to histamine in a similar

> way. It is possible that this reaction of mast cells to irritation and

> allergens results in the progression of damage to the system that

> controls the muscles in achalasia.

>

> Now consider this abstract:

>

> Interstitial cells of Cajal, macrophages and mast cells in the gut

> musculature: morphology, distribution, spatial and possible functional

> interactions.

> Mikkelsen HB.

> Department of Cellular and Molecular Medicine, Faculty of Health

> Sciences, University of Copenhagen, Copenhagen N, Denmark. hannem@...

> " Interstitial cells of Cajal (ICC) are recognized as pacemaker cells for

> gastrointestinal movement and are suggested to be mediators of

> neuromuscular transmission. ... In more chronic conditions such as

> Crohn's disease and achalasia, ICC and mast cells develop close spatial

> contacts and piecemeal degranulation is possibly triggered. "

>

> Interstitial cells of Cajal are reduced in number in achalasia. The

> damage in achalasia that causes loss of control for relaxing the LES is

> not just to the nerves but also to the ICC which interface with the

> nerves and muscles. In achalasia the close contact of mast cells and ICC

> puts the ICC at risk when the mast cells are triggered.

>

> So, be kind to your ICC. Don't trigger your esophageal mast cells by

> leaving them expose to irritants and allergens. By being kind to them

> you may slow the progression of achalasia, but there are no guarantees

> and more research is needed.

>

> notan

>